EP1703846B1

EP1703846B1 - Running stitch suturing device

Info

Publication number: EP1703846B1
Application number: EP05711412.6A
Authority: EP
Inventors: Jude S. Sauer; Mark A. Bovard; Michael W. Fitzsimmons; James W. Guelzow; John F. Hammond
Original assignee: LSI Solutions Inc
Current assignee: LSI Solutions Inc
Priority date: 2004-01-14
Filing date: 2005-01-13
Publication date: 2013-04-17
Anticipated expiration: 2025-01-13
Also published as: EP1703846A4; EP1703846A1; WO2005070305A1

Description

TECHNICAL FIELD

This invention relates generally to surgical suturing instruments and more particularly to a surgical suturing instrument in which a needle can be selectively engaged with a fitting at the end of the suture for pulling the suture through a tissue section and released from the suture for permitting subsequent stitches to be made.

BACKGROUND ART

Invasive therapeutic interventions typically provide for the removal of problematic tissue structures from the body followed by a need to reconstruct the involved tissues. Many alternatives are available for reconstructive interventions. Bandages can often close external wounds. The use of sutures placed within wound edges to draw tissues together to permit enhanced healing has become commonplace in modern medicine. Metallic or plastic staples and clips also can be used to appose tissue for healing.
WO 95/25468 A1 discloses a sewing device comprising a tissue penetrating member, a suture holder and means for coupling the tissue penetrating member to the suture holder for drawing a length of suture through a tissue section and for releasing the tissue penetrating member from the suture holder. A needle is movable between a first position in which it is out of the substrate portion and a second position in which it passes through the substrate portion. A flat carrier comprises a recess and a barb on the exterior of the thread carrier portion, wherein the barb is releasable from the tread carrier by rotation.
An intracardiac suture device for performing minimally invasive cardiac surgery on intracardiac defects without use of any artificial heart-lung system is described in EP 1 354 558 A2 .
A method for closing a punctured blood vessel which provides a suturing instrument adapted to apply at least one suture to at least a portion of blood vessel in order to close a punctured wound therein is disclosed in US 5,766 183 A .
To minimize the invasiveness of therapeutic procedures, efforts to create smaller access wounds that minimize iatrogenic tissue disruption have lead to better patient outcomes. For example, a minimally invasive surgical procedure, like laparoscopic partial colonic resection with intestinal reconnection (anastomosis), can facilitate less peri-operative pain, more rapid return of normal functions, earlier return to home and work. The placement of sutures during laparoscopic surgery can be slow, tedious and often not successful. Existing specialized instruments for minimally invasive surgery (Sauer) have recognized limitations. An instrument to enable the rapid, precise placement of multiple suture bites with the same suture and then facilitate rapid, secure knot creation would be a significant advance.

DISCLOSURE OF INVENTION

Briefly stated and in accordance with certain presently preferred embodiments of the invention, a surgical suturing instrument includes an elongated shaft, a tissue engaging gap formed in an end of the shaft, a needle reciprocally movable across the gap from a proximal end of the gap to a distal end of the gap, the needle having a ferrule engaging tip and a ferrule receiving aperture at a distal end of the gap for selectively holding and releasing a ferrule so that in a first mode the needle engages the ferrule and draws the suture across the gap and in a second mode, the ferrule is retained in the aperture and the needle separates from the ferrule and is retracted across the gap leaving the ferrule in the aperture.
In accordance with another aspect of the invention, a surgical suturing instrument for placing multiple suture loops in tissue comprises on elongated shaft, a reciprocal suture pick up member mounted on the shaft, a suture holder engaged by the reciprocating suture pick up member for selectively coupling a suture to the pick up member for drawing the suture through a first tissue section and releasing the suture from the pick up member for repeated coupling and drawing the suture through a second tissue section spaced from the first tissue section.
In accordance with another aspect of the invention, a surgical suturing instrument includes reciprocating tissue penetrating member, a suture holder, and apparatus for alternately coupling the reciprocating tissue penetrating member to the suture holder for drawing a length of suture through a tissue section and releasing the reciprocating tissue penetrating member from the suture holder.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing objects, features and advantages of the invention will become more apparent from a reading of the following description in connection with the accompanying drawings, in which:
FIG. 1 is a perspective view of the tissue suturing instrument in accordance with the present invention;
FIG. 2 is a partial side view of the tissue suturing instrument of FIG. 1 in which the right cover of the housing of the instrument is removed;
FIG. 3 is an exploded perspective view of the tissue suturing instrument of FIG. 1 in which the right cover of the housing is removed;
FIGS. 4A-4C are perspective views of the thumb slide holder of FIG. 3 showing this component from the top left, top right and bottom right perspectives, respectively;
FIG. 5A is a partially exploded perspective view of the thumb slide mechanism of FIG. 3 highlighting the thumb button and the retaining lock features;
FIG. 5B is a perspective view of an assembled thumb slide mechanism of FIG. 3 showing the thumb button in its fully out position;
FIG. 6A is a left perspective view of the thumb slide mechanism of FIG. 3 with its balled needle fully back and its accompanying lever fully out;
FIG. 6B is a left perspective view of the thumb slide mechanism of FIG. 3 with its balled needle fully forward and its accompanying lever fully retracted;
FIG. 7A is a right perspective view of the thumb slide mechanism of FIG. 3 with its thumb button and ferrule stripper fully back and its accompanying lever fully out;
FIG. 7B is a right perspective view of the thumb slide mechanism of FIG. 3 with it thumb button and ferrule stripper fully forward and its accompanying lever fully retracted;
FIG. 8A is an exploded perspective view of the distal tip of the instrument of FIG. 1 showing the distal tube, jaw, needle, ferrule stripper and ferrule retainer;
FIG. 8B is a perspective view of the underside of the distal tip of FIG. 1 showing the ferrule stripper alignment ramp and the ferrule holding compartment;
FIG. 9A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed and both the thumb button and the lever are fully out;
FIG. 9B is a right perspective view of the distal tip of the components of FIG. 9A showing the ferrule in its compartment;
FIG. 9C is a partial cross-sectional view of the distal tip of the components of FIG. 9A with the ferrule in its compartment and the needle and ferrule stripper fully back;
FIG. 9D is a side view of the proximal components of FIG. 9A showing the lever and thumb button fully out;
FIG. 9E is a right perspective view of the drive mechanism of the instrument of FIG. 3 with its thumb slide holder removed, the lever partially retracted and the thumb button fully out;
FIG. 9F is a right perspective view of the distal tip of the components of FIG. 9E with the needle partially advanced and the ferrule in its compartment;
FIG. 9G is the partial cross-sectional view of the distal tip of the components of FIG. 9E showing the ferrule in its compartment, the needle partially advanced and the ferrule stripper fully back;
FIG. 9H is a side view of the proximal components of FIG. 9E showing the lever partially retracted and the thumb button fully out;
FIG. 9J is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever fully retracted and the thumb button fully out;
FIG. 9K is a right perspective view of the distal tip of the components of FIG. 9J showing the needle fully advanced and engaging the ferrule in its compartment;
FIG. 9L is a partial cross-sectional view of the distal tip of the components of FIG. 9J with the needle engaging the ferrule in its compartment and the ferrule stripper fully back;
FIG. 9M is a side view of the proximal components of FIG. 9J showing the lever fully retracted and the thumb button fully out;
FIG. 10A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, with the thumb button fully out, the lever partially forward and the needle attached to the ferrule and suture partially back;
FIG. 10B is a right perspective view of the distal tip of the components of FIG. 10A showing the needle attached to the ferrule with suture partially retracted;
FIG. 10C is a partial cross-sectional view of the distal tip of the components of FIG. 10A showing the needle attached to the ferrule and suture partially retracted and the ferrule stripper fully back;
FIG. 10D is a side view of the proximal components of FIG. 10A showing the lever partially back and the thumb button fully out;
FIG. 1 0E is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever fully out and the thumb button fully out;
FIG. 10F is a right perspective view of the distal tip of the components of FIG. 10E showing the needle attached to the ferrule and suture fully retracted and the ferrule stripper fully back;
FIG. 10G is a perspective side view of the distal tip of the components of FIG. 10E showing the needle attached to the ferrule and suture fully retracted and the ferrule stripper fully back;
FIG. 10H is a side view of the proximal components of FIG. 10E showing the lever fully out and the thumb button fully out;
FIG. 11 A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever partially retracted, the needle with its ferrule and suture partially advanced and the thumb button fully out;
FIG. 11 B is a right perspective view of the distal tip of the components of FIG. 11 A showing the needle attached to the ferrule and the suture partially advanced;
FIG. 11C is a partial cross-sectional view of the distal tip of the components of FIG. 11 A showing the needle attached to the ferrule and the suture partially advanced and the ferrule stripper fully back;
FIG. 11D is a side view of the proximal components of FIG. 11A showing the lever partially retracted and the thumb button fully out;
FIG. 11E is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed and the lever fully retracted and the thumb button fully out;
FIG. 11 F is a right perspective view of the distal tip of the components of FIG. 11 E with the needle fully advanced along with its attached ferrule and suture;
FIG. 11 G is a partial cross-sectional view of the distal tip of the components of FIG. 11 E showing the needle along with its attached ferrule and suture fully advanced into the ferrule compartment;
FIG. 11H is a side view of the proximal components of FIG. 11E showing the lever fully retracted and the thumb button fully out;
FIG. 11J is a close-up side view of the lock features of the components of FIG. 11H showing the flat engagement surface of the actuating member raising the proximal spring lock to disengage it from the timing tube;
FIG. 12A is a right partial view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever fully retracted, the needle with its attached ferrule and suture fully advanced and the thumb button partially advanced;
FIG. 12B is a right perspective view of the distal tip of the components of FIG. 12A showing the needle with its ferrule and suture fully advanced into the ferrule compartment and the ferrule stripper partially advanced;
FIG. 12C is a partial cross-sectional view of the distal tip of the components of FIG. 12A showing the needle attached to the ferrule and suture fully advanced and the ferrule stripper partially advanced;
FIG. 12D is a side view of the proximal components of FIG. 12A showing the lever fully retracted and the thumb button partially forward;
FIG. 12E is a close-up side view of the lock features of the components of FIG. 1 2D showing the flat engagement surface of the actuating member raising the proximal spring lock and the timing tube partially forward;
FIG. 1 2F is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever fully retracted, the needle with its attached ferrule and suture fully advanced, and the thumb button and ferrule stripper fully forward;
FIG. 12G is a right perspective view of the distal end of the components of FIG. 12F showing the needle with its ferrule and suture fully advanced and the ferrule stripper fully advanced and engaging the ferrule;
FIG. 12H is a partial cross-sectional view of the distal tip of the components of FIG. 12F showing the needle attached to the ferrule and the suture and the ferrule stripper fully advanced engaging the ferrule;
FIG. 12J is the side view of the proximal components of FIG. 12F showing both the lever and the thumb button fully forward;
FIG. 12K is a close-up side view of the lock features of FIG. 12J showing the flat engagement surface of the actuating member raising the proximal spring lock, the timing tube fully forward and engaging the released distal spring lock;
FIG. 13A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever partially released, the needle partially retracted, the ferrule stripper engaging the ferrule in its ferrule compartment and the thumb button fully forward;
FIG. 13B is a right perspective view of the distal tip of the components of FIG. 13A showing the needle partially retracted and the ferrule stripper fully forward;
FIG. 13C is a partial cross-sectional view of the distal tip of the components of FIG. 13A showing the needle partially retracted and the ferrule stripper fully forward engaging the ferrule in its compartment;
FIG. 13D is a side view of the proximal components of FIG. 13A showing the lever partially out and the thumb button fully forward;
FIG. 13E is a close-up side view of the lock features of FIG. 13D showing the convex engagement surface of the actuating member raising the distal spring lock and the thumb button released but still fully forward;
FIG. 13F is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever, needle, thumb button and ferrule stripper partially back;
FIG. 13G is a right perspective view of the distal tip of the components of FIG. 13F with the needle and ferrule stripper partially retracted and the ferrule back into its compartment;
FIG. 13H is a partial cross-sectional view of the distal tip of the components of FIG. 13F showing the needle and the ferrule stripper partially back and the ferrule and suture in the ferrule compartment;
FIG. 13J is a side view of the proximal components of FIG. 13F showing the lever and the thumb button partially back;
FIG. 13K is a close-up side view of the lock features of FIG. 13F showing the engagement surfaces of the actuating member not raising either of the spring locks;
FIG. 13L is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder removed, the lever, needle, thumb button and ferrule stripper fully back and the ferrule and suture reloaded into the ferrule compartment;
FIG. 13M is a perspective view of the distal tip of the components of FIG. 13L showing the needle and ferrule stripper fully retracted and the ferrule and suture in the ferrule compartment;
FIG. 13N is a partial cross-sectional view of the distal tip of the components of FIG. 13L showing the needle and ferrule stripper fully back and the ferrule and suture in the ferrule compartment;
FIG. 13P is a side view of the proximal components of FIG. 13L showing the lever and the thumb button fully back;
FIG. 13R is a close-up side view of the lock features of FIG. 13L showing the proximal spring clip engaging the timing tube;
FIGS. 14A-14E show an example of the suturing procedure using the tissue suturing instrument of FIG. 1 for placement of suture at the first site of the wound closure;
FIGS. 15A-1 5E show an example of the suturing procedure using the tissue suturing instrument of FIG. 1 for placement of suture at the second site of the wound closure;
FIGS. 16A-16D show an example of the suturing procedure using the tissue suturing instrument of FIG. 1 for placement of suture at the third site of the wound closure;
FIGS. 17A-1 7D show an example of the suturing procedure using the tissue suturing instrument of FIG. 1 for placement of suture at the fourth site of the wound closure;
FIGS. 18A-8E show an example of the use of the instrument of FIG. 1 to enable suture loop construction to initiate the tying of a suture knot;
FIGS. 19A-19F show an example of the instrument of FIG. 1 to construct further suture loops used to secure a suture knot;
FIG. 20 shows the suturing instrument of FIG. 1 used with a surgical grasper, which pulls on the free end of the suture to deliver the suture knot to the wound closure site;
FIG. 21 shows both the suturing instrument of FIG. 1 and a surgical grasper pulling on either ends of the suture to lock the knot in place to secure the wound closure;
FIGS. 22A-22C show an alternate exemplary method of securing the ends of the suture used in the suturing procedure illustrated in FIGS. 14A-17D by crimping a sleeve member over the ends of the suture;
FIGS. 23A-23D illustrate a running suturing procedure created using the tissue suturing instrument of FIG. 1 being secured by bolsters and a crimped sleeve member;
FIG. 24A is a perspective view of the distal tip of the second preferred embodiment of the tissue suturing instrument of FIG. 1 in which a stripper wedge causes a flexible member to grasp the ferrule;
FIG. 24B is a partial cross-sectional view of the distal tip of the second preferred embodiment of the tissue suturing instrument of FIG. 1 showing the needle engaging the ferrule and partial deployment of the stripper wedge;
FIG. 24C is a partial cross-sectional view of the distal tip of the second preferred embodiment of the tissue suturing instrument of FIG. 1 showing the stripper wedge engaging the flexing member which grasps the ferrule and allows the needle to retract leaving the ferrule in its ferrule compartment;
FIG. 25A is a perspective view of the distal tip of the third preferred embodiment of the tissue suturing instrument of FIG. 1 in which a stripper rod passes through the distal tip and engages the proximal face of the ferrule to enable stripping;
FIG. 25B is a broken-out section of the distal tip of the third preferred embodiment of the tissue suturing instrument of FIG. 1 in which a stripper rod rests in its internal chamber as the needle engages the ferrule in its ferrule pocket;
FIG. 25C is a broken-out section of the distal tip of the third preferred embodiment of the tissue suturing instrument of FIG. 1 in which the stripper rod protrudes from its internal chamber to engage the proximal face of the ferrule as the needle disengages the ferrule and retracts;
FIG. 26 is a partially exploded isometric view of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 in which a cam and follower mechanism and faceted needle are utilized to allow for automatic ferrule pick-up and release;
FIG. 27A is a close-up isometric view of the cam and follower mechanism of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 illustrating the needle fully retracted;
FIG. 27B is a close-up perspective view of the tip of faceted needle of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 shown in its ferrule engaging configuration;
FIG. 27C is a close-up isometric view of the cam and follower mechanism of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 illustrating the needle partially advanced and the follower mechanism actuating the cam and rotating the needle;
FIG. 27D is a close-up perspective view of the tip of faceted needle shown partially rotated as it is advancing;
FIG. 27E is a close-up isometric view of the cam and follower mechanism of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 illustrating the needle fully advanced;
FIG. 27F is a close-up perspective view of the tip of faceted needle of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 shown fully advanced and rotated to its ferrule stripping configuration;
FIG. 28 is a close-up perspective view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing a partially advanced faceted needle, the ferrule in its ferrule compartment and a ferrule latch adjacent to the ferrule pocket;
FIG. 29A is a close-up perspective view of the stripping mechanism of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the ferrule latch disengaged and allowing the faceted needle to retrieve the ferrule;
FIG. 29B is a close-up perspective view of the stripping mechanism of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the ferrule latch engaged and enabling the stripping of the faceted needle from the ferrule;
FIG. 30A is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle fully retracted and the ferrule in its ferrule compartment;
FIG. 30B is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle fully extended, disengaging the ferrule latch, and connecting with the ferrule in its ferrule compartment;
FIG. 30C is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle beginning to retract with its attached ferrule and suture;
FIG. 30D is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle retracting with its attached ferrule and suture and the ferrule latch returning to its normal state;
FIG. 30E is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle fully retracted with its attached ferrule and suture;
FIG. 30F is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle extending and returning the ferrule and its suture to the ferrule compartment;
FIG. 30G is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle fully extended, the ferrule and its suture returned to the ferrule compartment and the ferrule latch engaged with the proximal face of the ferrule;
FIG. 30H is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle retracting and the ferrule latch retaining the ferrule in its ferrule compartment;
FIG. 30J is a partial cross-sectional view of the distal tip of the fourth preferred embodiment of the tissue suturing instrument of FIG. 1 showing the faceted needle fully retracted and awaiting the next cycle of firing of the instrument;
FIG. 31 is a perspective view of the tissue suturing instrument in accordance with another embodiment of the present invention;
FIG. 32 is a partial side view of the tissue suturing instrument of FIG. 31 in which the right cover of the housing has been removed;
FIG. 32A is an enlarged partial side view of the distal tip of the tissue suturing instrument of FIG. 31.
FIG. 33 is an exploded perspective view of the tissue suturing instrument of FIG. 31 in which the right cover of the housing has been removed.
FIG. 34A and 34B are perspective views of the lever of FIG. 33 showing this component from the distal top and proximal top perspectives, respectively;
FIG. 35 is a perspective view of the selector mechanism of FIG. 33 highlighting the balled needle selection and balled needle liberation features;
FIG. 36 is perspective view of the selector shuttle of FIG. 33 highlighting the balled needle retention features;
FIG. 37A is a right perspective view of the lever and balled needle selector mechanism of FIG. 33 with the lever fully advanced and its accompanying balled needles fully back and the selector mechanism positioned over the left balled needle;
FIG. 37B is a right perspective view of the lever and balled needle selector mechanism of FIG. 33 with the lever fully retracted forcing the left balled needle to advance while allowing the right balled needle to remain retracted;
FIG. 38A is a right perspective view of the lever and balled needle selector mechanism of FIG. 33 with the lever fully advanced and its accompanying balled needles fully back and the selector mechanism positioned over the right balled needle;
FIG. 38B is a right perspective view of the lever and balled needle selector mechanism of FIG. 33 with the lever fully retracted forcing the right balled needle to advance while allowing the left balled needle to remain retracted;
FIG. 39A is a right perspective view of the lever and selector mechanism of FIG. 33 with the lever fully advanced and its accompanying balled needles fully back and the selector mechanism positioned over the left balled needle with its follower in the left advancing track of the lever;
FIG. 39B is a right perspective view of the lever and selector mechanism of FIG. 33 with the lever fully retracted forcing the left balled needle to advance while allowing the right balled needle to remain retracted with the follower of the selector mechanism in the left advancing track of the lever;
FIG. 39C is a right perspective view of the lever and selector mechanism of FIG. 33 with the lever returned to its fully advanced position and its accompanying balled needles fully back and the selector mechanism positioned over the left balled needle with its follower in the left advancing track of the lever;
FIG. 39D is a right perspective view of the lever and selector mechanism of FIG. 33 with the lever fully advanced and its accompanying balled needles fully back and the selector mechanism now positioned over the right balled needle with its follower traversing the selection track of the lever;
FIG. 39E is a right perspective view of the lever and selector mechanism of FIG. 33 with the lever fully retracted forcing the right balled needle to advance while allowing the left balled needle to remain retracted with the follower of the selector mechanism in the right advancing track of the lever;
FIG. 39F is a right perspective view of the lever and selector mechanism of FIG. 33 with the lever returned to its fully advanced position and its accompanying balled needles fully back and the selector mechanism positioned over the right balled needle with its follower in the right advancing track of the lever;
FIG. 40A is an exploded perspective view of the adapter and spring arms of FIG. 33 as they are used in the actuation of the rotation cam;
FIG. 40B is a left perspective view of the adapter and spring arms of FIG. 33 showing the suture routing tube slot and cam bores;
FIG. 41 A is a side view of the rotation cam of FIG. 33 showing the advance/retract tracks, the rotation tracks, and the motion prevention lock-outs;
FIG. 41 B is a cross-sectional view of FIG. 41 A showing the needle bore, and the ramped track surfaces;
FIG. 41C is a flat-pattern view of the cam profile of FIG. 41 A showing the advance/retract tracks, the rotation tracks, and the motion prevention lock-outs;
FIG. 41 D is a perspective view of the rotation cam of FIG. 33 showing the needle bore, advancing and rotation tracks, advancing and rotation stops, and advancing and rotation ramps;
FIG. 41 E is a cross-sectional view of FIG. 41 D showing the needle bore as it passes centrally through the rotation cam and the profile of the advancing track with its ramp and stop;
FIG. 42 is a right perspective view of the balled needle of FIG. 33 showing the ferrule latch engaging and disengaging surfaces;
FIG. 42A is a partial side view of FIG. 42 illustrating the ferrule latch disengaging surfaces without facets;
FIG. 42B is a partial side view of FIG. 42 illustrating the faceted ferrule latch engaging surface;
FIG. 43 is a right perspective view of the fully advanced lever and a partial cross-section of the adapter of FIG. 33 as they interface with the fully retracted balled needle and its accompanying rotation cam;
FIG. 43A is a right perspective view of a partial cross-section of the adapter of FIG. 43 showing the spring arm as it engages in a fully retracted rotation cam;
FIG. 43B is a partial right perspective view of the tip of the balled needle of FIG. 43 showing the orientation of the ferrule latch engaging and disengaging faces;
FIG. 44 is a right perspective view of the partially retracted lever and a partial cross-section of the adapter of FIG. 33 as they interface with the partially advanced balled needle and its accompanying rotation cam;
FIG. 44A is a right perspective view of a partial cross-section of the adapter of FIG. 44 showing the spring arm as it engages in a partially advanced rotation cam;
FIG. 45 is a right perspective view of the fully retracted lever and a partial cross-section of the adapter of FIG. 33 as they interface with the fully advanced balled needle and its accompanying rotation cam;
FIG. 45A is a right perspective view of a partial cross-section of the adapter of FIG. 45 showing the spring arm as it engages in a fully advanced rotation cam;
FIG. 45B is a partial right perspective view of the tip of the balled needle of FIG. 45 showing the orientation of the ferrule latch engaging and disengaging faces;
FIG. 46 is a right perspective view of the lever partially returned to its fully advanced state and a partial cross-section of the adapter of FIG. 33 as they interface with the balled needle and its accompanying rotation cam as they are partially returned to their fully retracted state;
FIG. 46A is a right perspective view of a partial cross-section of the adapter of FIG. 46 showing the spring arm as it engages in the rotation cam as it rotates during its partial return to its fully retracted position;
FIG. 46B is a partial right perspective view of the tip of the balled needle of FIG. 46 showing the orientation of the ferrule latch engaging and disengaging faces as the cam begins to rotate as it is being retracted;
FIG. 47 is a right perspective view of the now fully advanced lever and a partial cross-section of the adapter of FIG. 33 as they interface with the balled needle and its accompanying rotation cam as they are fully retracted;
FIG. 47A is a right perspective view of a partial cross-section of the adapter of FIG. 47 showing the spring arm as it engages in the rotation cam as it completes its rotation upon returning to its fully retracted position;
FIG. 47B is a partial right perspective view of the tip of the balled needle of FIG. 47 showing the orientation of the ferrule latch engaging and disengaging faces as the cam completes its rotation and is fully retracted;
FIG. 48 is an exploded perspective view of the underside of the distal tip of the instrument of FIG. 31 showing the sew tip and the ferrule latch;
FIG. 49A is a perspective view of the ferrule latch of FIG. 48 depicting how the ferrule latch flexes in relation to the pocketed ferrules when encountered by the ferrule latch engaging face of left balled needle;
FIG. 49B is a perspective view of the ferrule latch of FIG. 48 depicting how the ferrule latch flexes in relation to the pocketed ferrules when encountered by the ferrule latch engaging face of right balled needle;
FIG. 50A is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating both balled needles fully retracted and the ferrule latch retaining both sutures and attached ferrules best depicting the lever and cam operations shown in FIGS. 43 and 43A, respectively;
FIG. 50B is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right balled needle fully retracted, the left balled needle partially advanced, and the ferrule latch retaining both sutures and attached ferrules best depicting the lever and cam operations shown in FIGS. 44 and 44A, respectively;
FIG. 50C is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right balled needle fully retracted, the left balled needle fully advanced and engaging the ferrule latch to release only the left suture and attached ferrule best depicting the lever and cam operations shown in FIGS. 45 and 45A, respectively;
FIG. 50D is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right balled needle fully retracted, the left balled needle beginning its retraction and rotation while retaining the left suture and attached ferrule and disengaging the ferrule latch allowing it to return to its normal state best depicting the lever and cam operations shown in FIGS. 46 and 46B, respectively;
FIG. 50E is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right and left balled needles fully retracted and pulling the left suture and attached ferrule across the jaw best depicting the lever and cam operations shown in FIGS. 47 and 47A, respectively;
FIG. 50F is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right balled needle fully retracted, the left balled needle partially advanced and beginning to return the left suture and attached ferrule to its pocket best depicting the lever and cam operations shown in FIGS. 44 and 44A, respectively;
FIG. 50G is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right balled needle fully retracted, the left balled needle fully advanced and returning the left suture and attached ferrule to its pocket while not engaging the ferrule latch best depicting the lever and cam operations shown in FIGS. 45 and 45A, respectively;
FIG. 50H is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating the right balled needle fully retracted, the left balled needle beginning its retraction and rotation while both sutures and attached ferrules are retained by the ferrule latch allowing it to return to its normal state best depicting the lever and cam operations shown in FIGS. 46 and 46A, respectively;
FIG. 50J is a perspective view of the underside of the distal tip assembly of the instrument of FIG. 31 illustrating both balled needles fully retracted and the ferrule latch retaining both sutures and attached ferrules best depicting the lever and cam operations shown in FIGS. 47 and 47A, respectively;
FIGS. 51A-51H illustrate a an exemplary method of tying a unique knot with the instrument 16 of FIG. 31.

MODES FOR CARRYING OUT THE INVENTION

The first preferred embodiment of this invention, suturing instrument 16, is represented in FIGS. 1-13R. Referring to FIGS. 1-3, show the suturing instrument 16, which represents the SEW-RIGHT ^® SR•5^® manufactured by LSI SOLUTIONS, Inc. (formerly LaserSurge, Inc.) of Victor, New York, that has been modified to provide a means for selectably stripping its ferrule 103 from the needle 34 at its tissue engaging end 16a. The tissue engaging end 16a and needle 34 thereto may be similar to that shown in U.S. Patent Nos. 5,431,666 , 5,766,183 , European Patent No. EP 0669101, filed February 23, 1995 and granted October 14, 1998, or U.S. Patent Application Publication No. US 2002/0107530 A1, filed February 2, 2001 .
The housing 30 has a body shaped like a pistol having a handle portion 30a, and may be made of a two-piece construction of molded plastic. A needle 34 extends from housing 30 through the shaft 16b into the tissue engaging end 16a. Needle 34 has a non-tissue engaging end 34b in the housing 30 having a spherical member 34a, such as a ball or bearing, respectively, attached thereto. The needle 34 and spherical member 34a may be made of metal, such as surgical stainless steel. The spherical member 34a may have a bore into which the non-tissue engaging end 34b of the needle 34 extends and joins thereto, such as by welding or brazing.
The suturing instrument 16 includes an actuating member 36 representing a lever 36a having two pins 36b extending into holes 30b in the sides of housing 30 upon which the actuating member 36 is pivotally mounted in the housing 30. Actuating member 36 has a portion which extends through a lever opening 30c (FIG. 2) in housing 30 to enable pivotal movement about pins 36b. An extension spring 38 is provided which hooks at one end in a notch 36c of actuating member 36 and is wound at the other end around a pin 40 located in holes 30f in the sides of housing 30, such that the actuating member 36 is spring biased to retain actuating member 36 normally in a forward position, fully out, as shown for example in FIG. 2. The body of housing 30 has a front pivot stop 30e (FIG. 3) providing a stop that limits the pivotal movement of the actuating member 36. A notch 36c is provided in the actuating member 36 which is shaped to receive the non-engaging end of needle 34, i.e., spherical member 34a, to be driven forward by an operator pulling actuating member 36 to pivot actuating member 36 towards handle portion 30a. The groove 36d (FIG. 3) is provided by two fingers 36e into which the needle 34 near the spherical member 34a may lie.
As shown in FIGS. 4B and 4C, a thumb slide holder 42 is fixed in housing 30 by two flanges 42a above actuating member 36. As best shown in FIG. 4A, the thumb slide holder 42 has a chamber 42b with a groove 42d formed by fingers 42e which allow the needle 34 to be received in chamber 42b to restrict movement of the needle 34 when held therein. The lower surface 42f of thumb slide holder 42 is curved and faces correspondingly curved upper surface 36f of actuating member 36, such that the actuating member 36 is slidable along lower surface 42f responsive to the operator pulling the actuating member 36.
The adapter 48 has a bore extending there through in which a needle spreader 50 is located. Needle spreader 50 has two channels 50b and 50c into which needle 34 and ferrule stripper 35 are respectively located to increase the distance between the needle 34 and the ferrule stripper 35 as they extend toward thumb slide holder 42, such that the needle 34 and ferrule stripper 35 are properly aligned.
A suture routing tube 47 is provided for suture thread in housing 30. Suture routing tube 47 has one end received in a valve assembly 19, at the bottom of handle portion 30a of housing 30 and then extends through the suture routing tube notch 30d (FIG. 3) along the interior of the left side of housing 30, and a groove 50a along needle spreader 50 (FIG. 3). The other end of the suture routing tube 47 is then mounted in suture routing tube hole 51 a through gasket 51. Gasket member 51 further has two holes 51 b and 51 c through which needle 34 and ferrule stripper 35, respectively extend. The gasket 51 may be made of medical grade rubber, such as Santoprene^®.
A longitudinal guide member 53 is provided multiple tracks along its length, including two tracks 53a and 53b for needle 34 and ferrule stripper 35, respectively, and a suture track 53c for suture 105 extending from opening 51 a of gasket 51. The guide member 53 may be made of extruded flexible material, such as Tecoflex^®. A D-tube 52 is provided which is D-shaped at one end 52a is registered into a corresponding shaped opening in adapter 48, and a threaded nut 54 having an opening which extends over D-tube 52, screws onto the end of the adapter 48 to secure D-tube 52 to housing 30. With the gasket 51 loaded first into D-tube 52, guide member 53 extends from the gasket 51 through the D-tube 52. In this manner, tracks 53a, 53b, and 53c each form a channel with the interior surface of D-tube 52. D-tube 52 may be made of stainless steel, or other rigid material, and has for example, D-tube 52 has an outside diameter of 0.516 cm (0.203 inches). (Note for other applications, such as flexible endoscopy, this tube could be flexible.) Inside D-tube 52, gasket 51 has a ring 51d, which frictionally engages the interior surface of D-tube 52. Hole 51 a of the gasket 51 is of a diameter such that the suture tube 47 tightly fits therein and provides a seal around suture tube 47. The suture tube 47 may be held in place in hole 51 a by friction, but adhesive may also be used. Holes 51 b and 51 c are of a larger diameter than the needle 34, except for a small section of holes 51 b and 51 c where the diameter reduces to form flaps of gasket material which seal around needle 34 and ferrule stripper 35, respectively. This enables movement of the needle 34 and ferrule stripper 35 tube back and forth while maintaining a seal about the needle 34 and ferrule stripper 35. One featu re of the gasket 51 is that it enables sealing the shaft 16b as well.
The guide member 53 is received into the D-tube 52, such that guide member 53 abuts gasket 51 and engages distal tip 98. Distal tip 98 is attached to the D-tube 52 by mechanical fastening by forming small dents 52c in the metal of the D-tube 52 with a press into recessed four pockets 98b (FIG. 3), i.e., two on each side of the distal tip 98.
An optional valve assembly 19 can be provided at the bottom of handle portion 30a, as shown in FIG. 3, having a valve seat 19a and a valve controller 19b. Valve seat 19a is composed of medical grade rubber, such as Santoprene^®, and has a through hole extending into an interior chamber. A valve controller 19b composed of molded plastic, or other rigid material, has a circular section through an opening and a surface forming a cam that can be turned to select a valve fully open to intermediate partially open to a fully closed position. The suture routing tube 47 is received in hole 76 of valve seat 19a, as shown in FIG. 3, such that suture 105 material from the tube can pass through openings of the valve seat 1 9a and then through the valve controller 19b.
Referring to FIGS. 2 and 3, the tissue engaging end 16a of the suturing instrument 16 is shown having the distal tip 98 which is mounted in a D-tube 52, such that the front section 98a of the distal tip 98 extends from D-tube 52.
Referring to FIGS. 4A-4C, the thumb slide holder 42 is shown. The thumb slide holder 42 may be made of a one-piece construction of molded plastic. The thumb slide holder 42 is fixed in the housing 30 above the actuating member 36 by two opposing flanges 42a, as best shown in FIG. 4B.
As best represented in FIG. 4A, the thumb slide holder 42 has a chamber 42b through which the positive stop 41 b of the timing tube 41 c is located. One groove 42d formed by two fingers 42e allows the needle 34 (FIG. 3) to pass through the thumb slide holder 42 through the groove 36d formed by the two fingers 36e of the actuating member 36 and enables the spherical member 34a to rest in the notch 36c of the actuating member 36. The lower curved surface 42f extends over the curved upper surface 36f of the actuating member 36 to further retain the needle 34 and spherical member 34a in the notch 36c throughout the entire range of motion of the actuating member 36.
The housing 42g of the thumb slide holder 42 is fashioned to accommodate and guide the thumb button 41 e (FIG. 3). The thumb button stop 42k serves as a motion-limiting surface to prevent the thumb button 41 e from traveling farther than intended. The thumb slide holder 42 has a bore 42c for the timing tube 41 c (FIG. 3) is located. Contained within the housing 42g is a raised region 42h to enable alignment of the return spring 46 (FIG. 3) and resting surface 42j which seats and retains the return spring 46.
FIG. 4C shows a perspective view of the thumb slide holder 42 and timing tube stop 42l which provides a positive engagement surface for the positive stop 41 b to limit the advance of the timing tube 41 c. The thumb slide holder 42 may further have a channel 42p forward of the groove 42d to provide clearance for suture routing tube 47 (FIG. 3). The body of the thumb slide holder 42 has lock spring bores 42n and spring lock channels 42m to provide for the assembly, alignment, and retaining of the lock spri ngs 45 and distal spring lock 43 and proximal spring lock 44, respectively and best represented in FIGS. 5A and 5B.
FIG. 5A shows the push button assembly 41 interfacing with other components. The timing tube 41 c is shown with the thumb button 41 e attached thereto. Housed inside the thumb button 41 e is the return spring 46 which serves as a return mechanism for the assembly. The ferrule stripper 35 is received into the distal opening 41 d and coupled to the timing tube 41 c via an insert molding or adhesive process. The lock springs 45 are inserted into the thumb slide holder 42 and followed with the proximal spring lock 44 and the distal spring lock 43. With the proximal spring lock 44 and the distal spring lock 43 inserted in the thumb slide holder 42 and compressed, the push button assembly 41 with attached ferrule stripper 35 is inserted into the thumb slide holder 42 such that the positive stop 41 b passes into the chamber 42b and the proximal spring lock engages in the spring lock engagement slot 41 a. The ferrule stripper 35 continues through the adapter 48.
FIG. 5B shows a perspective view of the underside of assembled push button assembly 41, thumb slide holder 42, adapter 48, nut 54, and D-tube 52 and highlights the relative location of the proximal spring lock 44 and distal spring lock 43.
Referring to FIGS. 6A and 6B, the operation of the actuating member 36 and the needle 34 is described. As the actuating member 36 is engaged, rotating about the pins 36b, the needle 34 and the attached spherical member 34a are advanced as the spherical member 34a is in contact with the notch 36c of the actuating member 36.
FIGS. 7A and 7B illustrate the operation of the push button assembly 41 and the ferrule stripper 35. The actuating member 36 is engaged, rotating about the pins 36b until the flat engagement surface 36g comes into contact with and forces the proximal spring lock 44 out of the spring lock engagement slot 41 a (FIG. 5A) allowing the forward motion of the push button assembly 41 and the coupled ferrule stripper 35. This forward motion is limited primarily by the engagement of distal spring lock 43 with spring lock engagement slot 41 a (FIG. 5A). Advancement of timing tube 41 c is also limited by engaging the adapter 48.
FIG. 8A shows the assembly of the distal tip 98 and the ferrule retainer 99 with the D-tube 52, the needle 34, and the ferrule stripper 35. The distal tip 98 has a gap 104 in a c-shaped jaw 104 having two openings 98c at one side of the gap through which each needle 34 and ferrule stripper 35 may extend The needle 34 and the ferrule stripper 35 are received into the needle/stripper openings of the distal tip 98 and the distal tip 98 is then coupled to the D-tube 52 which may be achieved by mechanical fastening forming small dents in the metal of the D-tube 52 with a press into four recessed pockets 98b, i.e., two on each side of the distal tip 98. The ferrule retainer 99 is inserted into the ferrule retainer hole 98e until the ring 99a seats into the opening created where the ferrule retainer hole 98e intersects the ferrule pocket 107 as best shown in FIG. 8B. The suture 105 attached to the ferrule 103 enters the ferrule compartment 107 through the open slot located on the side of the ferrule chamber opposite from the ferrule retainer 99.
FIGS. 9A-13R represent highlights of twelve sequential steps overviewing the loading, reloading and locking operations through one complete cycle of use of instrument 16. For example, the first three steps presented in FIGS. 9A-9M, illustrate the needle 34 first advancing into the ferrule 103.
FIGS. 9A-9D show the instrument loaded and ready for use, the first step. FIG. 9A shows a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed and both the thumb button 41 e and the lever 36a are fully out; the proximal spring lock 44 engages the timing tube 41 c. FIG. 9B is a right perspective view of the distal tip 98 of the components of FIG. 9A showing the ferrule 103 in its ferrule compartment 107 and the jaw 104. FIG. 9C is a partial cross-sectional view of the distal tip 98 of the components of FIG. 9A with the ferrule 103 in its ferrule compartment 107, and the needle 34 and ferrule stripper 35 fully back. FIG. 9D is a side view of the proximal components of FIG. 9A showing the lever 36a and thumb button 41 fully out. Proximal spring lock 44 is shown engaging spring lock engagement slot 41a of timing tube 41c.
FIGS. 9E-9H show partial advancement of the needle 34 as part of the second step. FIG. 9E is a right perspective view of the drive mechanism of the instrument of FIG. 3 with its thumb slide holder 42 removed, the lever 36a partially retracted and the thumb button 41 e fully out. FIG. 9F is a right perspective view of the distal tip 98 of the components of FIG. 9E with the needle 34 partially advanced and the ferrule 103 in its ferrule compartment 107. FIG. 9G is the partial cross-sectional view of the distal tip 98 of the components of FIG. 9E showing the ferrule 103 in its ferrule compartment 107, the needle 34 partially advanced and the stripper 35 fully back. FIG. 9H is a side view of the proximal components of FIG. 9E showing the lever 36a partially retracted and the thumb button 41 e fully out.
FIGS. 9J-9M show the needle 34 fully advanced and engaged inside of the ferrule 103 as part of the third step. FIG. 9J is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a fully retracted and the thumb button 41 e fully out. FIG. 9K is a right perspective view of the distal tip 98 of the components of FIG. 9J showing the needle 34 fully advanced to engage the ferrule 103 in its ferrule compartment 107; best shown in FIG. 9L. FIG. 9L is a partial cross-sectional view of the distal tip 98 of the components of FIG. 9J with the needle 34 engaging the ferrule 103 in its ferrule compartment 107 and the ferrule stripper 35 fully back. FIG. 9M is a side view of the proximal components of FIG. 9J showing the lever 36a fully retracted and the thumb button 41 e fully out. Note that the flat engagement surface 36g is shown raising the proximal spring lock 44 out of the spring lock engagement slot 41 a.
The next two steps presented in FIGS. 10A-10H, illustrate the needle 34, now attached to the ferrule 103 and its suture 105, being retracted fully back. FIGS. 10A-10D show the needle 34 pulling its ferrule 103 back through jaw 104. FIG. 10A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, with the thumb button 41 e fully out, the lever 36a partially forward and the needle 34 attached to the ferrule 103 and suture 105 partially back. FIG. 10B is a right perspective view of the distal tip 98 of the components of FIG. 10A showing the needle 34 attached to the ferrule 103 with suture 105 partially retracted. FIG. 10C is a partial cross-sectional view of the distal tip 98 of the components of FIG. 10A showing the needle 34 attached to the ferrule 103 and suture 105 partially retracted and the ferrule stripper 35 fully back. FIG. 1 0D is a side view of the proximal components of FIG. 10A showing the lever 36a partially back and the thumb button 41 e fully out.
FIGS. 10E-1 0H show this instrument 16 with the ferrule 103 and its suture 105 attached to the fully retracted needle 34. FIG. 1 0E is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a fully out and the thumb button 41 e fully out. FIG. 10F is a right perspective view of the distal tip 98 of the components of FIG. 10E showing the suture 105 fully retracted and the ferrule stripper 35 fully back. FIG. 10G is a perspective side view of the distal tip 98 of the components of FIG. 10E showing the needle 34 attached to the ferrule 103 and suture 105 fully retracted and the ferrule stripper 35 fully back. FIG. 10H is a side view of the proximal components of FIG. 10E showing the lever 36a fully out and the thumb button 41 e fully out.
FIGS. 11A-11J show the next two steps representing reinsertion of the ferrule 103 into it ferrule compartment 107. FIGS. 11A-11E show the partial advancement of the needle 34 with its attached ferrule 103 and suture 105. FIG. 11 A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a partially retracted, the needle 34 with its ferrule 103 and suture 105 partially advanced and the thumb button 41 e fully out. FIG. 11 B is a right perspective view of the distal tip 98 of the components of FIG. 11 A showing the needle 34 attached to the ferrule 103 and the suture 105 partially advanced. FIG. 11C is a partial cross-sectional view of the distal tip 98 of the components of FIG. 11 A showing the needle 34 attached to the ferrule 103 and the suture 105 partially advanced and the ferrule stripper 35 fully back. FIG. 11 D is a side view of the proximal components of FIG. 11 A showing the lever 36a partially retracted and the thumb button 41e fully out.
FIGS. 11 E-11J show the needle 34 fully advanced attached to the ferrule 103 and its suture 105. Note that at this step of the operation, FIG. 11J is provided to show an enlarged view of the distal spring lock 43 and proximal spring lock 44. FIG. 11 E is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed and the lever 36a fully retracted and the thumb button 41 e fully out. FIG. 11 F is a right perspective view of the distal tip 98 of the components of FIG. 11 E with the needle 34 fully advanced into the ferrule 103. FIG. 11 G is a partial cross-sectional view of the distal tip 98 of the components of FIG. 11 E showing the needle 34 along with its attached ferrule 103 and suture 105 fully advanced into its ferrule compartment 107. FIG. 11H is a side view of the proximal components of FIG. 11E showing the lever 36a fully retracted and the thumb button 41 e fully out. FIG. 11J is a close-up side view of the lock features of the components of FIG. 11H showing the flat engagement surface 36g of the actuating member 36 raising the proximal spring lock 44 to disengage it from the spring lock engagement slot 41 a of the timing tube 41c.
FIGS. 12A-12K illustrate the next two steps to complete advancement of the ferrule stripper 35. FIGS. 12A-12E show the advancing of the push button assembly 41 to partially advance towards stripping the ferrule 103 from the fully advanced needle 34. FIG. 1 2A is a right partial view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a fully retracted, the needle 34 with its attached ferrule 103 and suture fully advanced and the thumb button 41 e partially advancing the ferrule stripper 35. FIG. 12B is a right perspective view of the distal tip 98 of the components of FIG. 12A showing the needle 34 with its ferrule 103 and suture 105 fully advanced into its ferrule compartment 107 and the ferrule stripper 35 partially advanced. FIG. 12C is a partial cross-sectional view of the distal tip 98 of the components of FIG. 12A showing the needle 34 attached to the ferrule 103 and suture 105 fully advanced and the ferrule stripper 35 partially advanced.
FIG. 12D is a side view of the proximal components of FIG. 12A showing the lever 36a fully retracted and the thu mb button 41 e and its attached timing tube 41 c partially forward. FIG. 1 2E is a close-up side view of the lock features of the components of FIG. 12D showing the flat engagement surface 36g raising the proximal spring lock 44 out of the spring lock engagement slot 41 a and the timing tube 41 c partially forward.
FIGS. 12F-12K show the full advanceme nt of both the needle 34 and ferrule stripper 35. FIG. 12F is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a fully retracted, the needle 34 with its attached ferrule 103 and suture 105 fully advanced, and the thumb button 41 e advancing its ferrule stripper 35 fully forward. FIG. 12G is a right perspective view of the distal end of the components of FIG. 1 2F showing the needle 34 with its ferrule 103 and suture 105 fully advanced and the ferrule stripper 35 fully advanced and engaging the proximal edge of the ferrule 103, as best shown in Fig. 12H. FIG. 12H is a partial cross-sectional view of the distal tip 98 of the components of FIG. 12F showing the needle 34 attached to the ferrule 103 and the suture 105 and the ferrule stripper 35 fully advanced and flexed onto the needle 34 to engage the proximal edge of the ferrule 103. FIG. 12J is the side view of the proximal components of FIG. 12F showing both the lever 36a and the thumb button 41 e fully forward. FIG. 12K is a close-up side view of the lock features of FIG. 12J showing the actuating member 36 raising the proximal spring lock 44, allowing the distal spring lock 43 to engage the spring lock engagement slot 41 a in the timing tube 41 c. Note a relief 36j in the top of the actuating member 36 allows the distal spring lock 43 to travel downward and engage the spring lock engagement slot 41 a.
The last three steps, FIGS. 13A-13R, illustrate the complete retraction of both the needle 34 and ferrule stripper 35. FIGS. 13A-13E show the lever 36a partially forward to retract the needle 34 to strip the ferrule 103 by engaging ferrule 103 with the fully advanced ferrule stripper 35. FIG. 1 3A is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a partially released, the needle 34 partially retracted, the ferrule stripper 35 engaging the ferrule 103 in its ferrule compartment 107 and the thumb button 41 e fully forward.
FIG. 13B is a right perspective view of the distal tip 98 of the components of FIG. 13A showing the needle 34 partially retracted from its ferrule 103 (not visible in this view) and the ferrule stripper 35 fully forward. FIG. 13C is a partial cross-sectional view of the distal tip 98 of the components of FIG. 13A showing the needle 34 partially retracted and the ferrule stripper 35 fully forward engaging the ferrule 103 in its ferrule compartment 107. FIG. 13D is a side view of the proximal components of FIG. 13A showing the lever 36a partially out and the thumb button 41 e fully forward. FIG. 13E is a close-up side view of the lock features of FIG. 13D showing the convex engagement surface 36h of the actuating member 36 (FIG. 13D) raising the distal spring lock 43 to disengage the spring lock engagement slot 41 a of the timing tube 41 c.
FIGS. 13F-13K show both the needle 34 and ferrule stripper 35 partially returning with the ferrule 103 replaced back into its ferrule, compartment 107. FIG. 13F is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a, needle 34, thumb button 41 e and ferrule stripper 35 partially back. FIG. 13G is a right perspective view of the distal tip 98 of the components of FIG. 13F with the needle 34 and ferrule stripper 35 partially retracted and the ferrule 103 back into its ferrule compartment 107. FIG. 1 3H is a partial cross-sectional view of the distal tip 98 of the components of FIG. 13F showing the needle 34 and the ferrule stripper 35 partially back and the ferrule 103 and suture 105 in the ferrule compartment 107. FIG. 13J is a side view of the proximal components of FIG. 13F showing the lever 36a and the thumb button 41 e partially back. FIG. 13K is a close-up side view of the lock features of FIG. 13F showing the engaging surfaces 36f-36h of the actuating member 36 not raising the proximal spring lock 44 or the distal spring lock 43 with the spring lock engagement slot 41 a released.
FIGS. 13L-13R show the instrument reloaded, ready for use and are identical to FIGS. 9A-9D, respectively, while FIG. 13R highlights reengagement of the proximal spring lock 44 with the spring lock engagement slot 41 a. FIG. 13L is a right perspective view of the drive mechanism of the instrument of FIG. 3 with the thumb slide holder 42 removed, the lever 36a, needle 34, thumb button 41 e and ferrule stripper 35 fully back and the ferrule 103 and suture 107 reloaded into the ferrule compartment 107. FIG. 13M is a perspective view of the distal tip 98 of the components of FIG. 13L showing the needle 34 and ferrule stripper 35 fully retracted and the ferrule 103 and suture 107 in the ferrule compartment 107. FIG. 13N is a partial cross-sectional view of the distal tip 98 of the components of FIG. 13L showing the needle 34 and ferrule stripper 35 fully back and the ferrule 103 and suture 107 in the ferrule compartment. FIG. 13P is a side view of the proximal components of FIG. 13L showing the lever 36a and the thumb button 41e fully back. FIG. 13R is a close-up side view of the lock features of FIG. 13L showing the proximal spring lock 44 engaging the spring lock engagement slot 41a of the timing tube 41 c.
Now referencing FIGS. 14A-17D, showing the multiple placement of sutures to form a wound closure. FIGS. 14A-14E illustrate the use of this instrument for the placement of the first suture of a wound closure and the readiment of the instrument for subsequent bites. FIG. 14A shows the distal tip 98 of the instrument 16 above a wound closure 110. Note the distal side of the wound closure 110 has crosshatching for purposes of this illustration. FIG. 14B shows the device 16 with the needle 34 passing through the first bite 124 of the distal side of the wound 110. FIG. 14C shows the needle 34 retracted back with its ferrule 103 and suture 105 pulled through the wound 110. FIG. 14D shows the needle 34 now advanced through to place the ferrule 103 back into its ferrule compartment 107. FIG. 14E shows the needle 34 back after having its ferrule 103 stripped. The instrument is now ready for another bite.
Now referencing FIGS. 15A-1 5E, the device 16 is again placed into the wound 110 this time with the proximal side of the wound 110 in the instrument's jaw 104. The needle 34 will enter the tissue 120 as shown in FIG. 1 5A, traverse the tissue 120 and enter the ferrule compartment 107 as shown in FIG. 15B. FIG. 1 5C illustrates the needle 34, ferrule 103 and suture 107 pulled back leaving suture 105 through the first bite 126 on the proximal side of the wound closure 110. FIG. 15D shows the needle 34 advanced yet again. FIG. 15E shows the ferrule 103 back in its ferrule compartment 107.
FIG. 16A-16D shows the second suture placement on the distal side of the wound 110. FIG. 16A shows the needle 34 traversing the second site 127 on the distal wound 110 aspect. FIG. 16B shows the suture 105 through the second bite 127 on the distal side of the wou nd 110. FIG. 16C shows the needle 34, ferrule 103 and suture 105 advanced to the ferrule pocket. FIG. 16D shows the instrument again ready for the bite.
FIG. 1 7A-1 7D show the seco nd bite 128 on the proximal side of the wound closure 110. FIG. 17A shows the needle 34 going through the second site 128 of the proximal side of the wound closure 110. FIG. 17B shows the needle 34, ferrule 103 and suture 105 advanced back into its ferrule compartment 107. FIG. 17C shows the instrument with the ferrule 103 reloaded and the needle 34 and ferrule stripper 35 retracted back. FIG. 17D illustrates the appearance of the wound closure 110. If the sutures 105 were to be tied at this time, this type of closure is commonly called a figure of eight suture closure. If the process were to continue with further placements of suture 105 running along the distal and proximal aspects of the wound closure, this type of closure is typically be called a running suture wound closure.
Now referencing FIGS. 18A-21, FIG. 18A shows the instrument 16 of this invention with the distal tail of the suture 105 exposed and the distal tip 98 of the instrument 16 ready for knot tying. FIGS. 18A-19B show the first throw of the knot tying process. FIGS. 19C-19F show the second throw of the knot tying process. FIGS. 21 and 22 show the cinching down of the knot. In FIG. 18B, a surgical grasper 129, is used to grab the free end of the suture 105 and to wrap the suture 105 around the jaw 104 of the instrument 16. Note that to construct the knot, which we have named th e "Super Surgeon's knot," the first wrapping of suture 105 around the jaw 104 consists of two complete loops wrapped around the jaw 104. FIG. 18C shows the advancement of the needle 34, ferrule 103 and suture 105 back into its ferrule compartment 107, best shown in FIG. 18A, after the double wrap has been placed around the jaw 104 of the instrument 16. FIG. 1 8D shows the now stripped ferrule 103 in its ferrule compartment 107. FIG. 1 8E shows the knot forming double loops being slid down towards the wound closure site 110. FIG. 19A shows the grasper 129 further cinching the knot down to the wound closure site 110. FIG. 19B shows the suture 105 now fully retracted back on its needle 34 to further expose the jaw 104 of the knot tying instrument 16. FIG. 19C shows a second wrapping of a single loop placed around the distal tip 98 of the instrument 16 to secure the knot. FIG. 19D shows the needle 34 again advanced to replace the ferrule 103 in its ferrule compartment 107 along with the suture 105. FIG. 19E shows the ferrule 103 in its ferrule compartment 107 with the needle 34 and ferrule stripper 35 now back. FIG. 19F shows the second throw, a single loop throw, of the Super Surgeon's knot being slid over the ferrule 103 and suture 105 down towards the wound closure 110. FIG. 20D illustrates that by pulling on the surgical grasper 129 on the free end of the suture 105, the suture loops are further slid towards and down onto the wound closure 110 to begin to pull (also called approximate or appose) the edges of the wound 110 together, but not fully locking the knot in place. FIG. 21 shows by pulling on the surgical grasper 129 holding the free end of the suture 105, and now by simultaneously pulling on instrument 16 holding the ferrule 103 end of the suture 105, both ends of the suture 105 are drawn tight, thereby locking the Super Surgeon's knot in place. The distinct advantage of the Super Surgeon's knot is that it permits the user to place the knot above the wound closure and appropriately appose the sound edge by pulling only on the free end of the suture, and then, once the correct tissue apposition is achieved, the user can pull on the ferrule end of the suture to lock the knot down. Locking down the Super Surgeon's knot alone provides adequate holding force, at least temporarily, to hold together many types of wound closures. For example, a Super Surgeon's knot made with 2-0 STRONGSORB® suture by LSI SOLUTIONS, Inc., achieves an average tissue holding strengths of approximately 0.5 kg knot holding force to temporarily secure and tissue edges together. Subsequent throws on top of the Super Surgeon's knot will add additional knot holding force up to the native strength of the suture (e.g., with 2-0 STRONGSORB®, up to 5 to 6 kg tensile pull). No other knot is known (to the inventors) that can be constructed under such surgically relevant conditions and provides excellent tissue holding force immediately when the first throws are drawn together by pulling on both ends of the suture.
FIGS. 22A-22C illustrate an exemplary method of securing the free ends of the suture 105 left by the instrument 16, used to close the wound 110 in the tissue 120. FIG. 22A represents an instrument 1 30, which crimps a sleeve member 121 to secure suture 105 together and is commercially available as a Ti-KNOT ^® TK·5 ^®. Device manufactured by LSI SOLUTIONS, Inc., under at least the following patents U.S. Patent Numbers: 5,520,702 ; 5,643,289 and 5,669,917 . The free ends of the suture 105 are passed through the instrument 1 30 and the instrument 130 is passed closer to the wound closure 110. FIG. 22B illustrates the instrument 130 being applied directly to the wound closure 110 and both free ends of the suture 105 drawn tight, removing any slack and drawing the opposing sides of the wound closure 110 closer together. FIG. 22C shows the sleeve member 121 crimped around the suture 105 at the wound closure 110. Note that the suture 105 has been trimmed.
After using instrument 16 to place suture 105 for running a wound closure 110, one or both ends of the suture 105 may remain unsecured. These free ends of the suture 105 can be attached to pledgets or bolsters 122a and 122b to prevent their ability to be pulled into or away from the wound site 110. A pledget is typically a pliable, nonreactive piece of material, such as polyester mesh, Gortex^®, or the like, that is often used in conjunction with sutures or staples to augment wound closures. A bloster 122a is attached (e.g., by tying or sewing) to one end of an additional segment of suture 123a. By placing the free end of this bolstered suture 1 23a, along with one free end of the suture 105, the bolster 122a and its attached suture 123a can be passed down using suture 105 as a guide. Bolster 122a, suture 1 23a and one end of suture 105 can be secured at one end of the wound site 110 with a sleeve member 121. The bolster 122a can hold this end of the running suture 105 from being pulled into the wound 110. By repeating a similar bolstered suture 123b placement at the opposite end of the wound 110, the second bolster 122b and its suture 123b can hold the second suture 105 end from being pulled into the wound 110. Bolsters 122a and 122b secured at each end of the wound 110, prevent the suture 105 from being pulled out of the wound 110 from either direction.
FIGS. 24A-24C illustrate a second preferred embodiment of this invention. The main difference between this embodiment and the first preferred embodiment, is that instead of stripping the ferrule 103 with the ferrule stripper 35 traversing the gap and engaging the ferrule 103, the member that directly contacts the ferrule 103 for ferrule stripping is incorporated in the distal tip 98. The thumb button 41 e drive mechanism for this embodiment can be the same as in the first preferred embodiment. FIG. 24A shows a perspective of the distal jaw, which looks similar to the first embodiment, except instead of a slope to direct the stripper wedge 131 towards the ferrule, the stripper wedge 131 enters a chamber 141 and subsequently wedges member 133 against ferrule 103 to permit removal of the needle 34. FIG. 24B shows needle 34 engaging ferrule 103 in ferrule compartment 107 with the stripper wedge 131 traveling toward chamber 141. FIG. 24C shows the ferrule 103 held in its ferrule compartment 107 by stripper wedge 131 forcing over member 133. Needle 34 can now be extracted from ferrule 103. Stripper wedge 131 can be subsequently withdrawn leaving the ferrule 103 in it reloaded position.
FIGS. 25A-25C illustrate a third preferred embodiment of this invention. In this embodiment, unlike the prior two, the ferrule stripping element does not traverse the gap in the distal tip 98. Rather, in this embodiment, the stripper wedge 131, which can be a semi-flexible material, such as memory metal, Nitinol, or the like, passes through a channel in the bridge that traverses behind the gap in the jaw. This ferrule stripping embodiment can also be advanced towards the ferrule using a mechanism similar to the already described thumb slide mechanism 41 (FIG. 3). FIG. 25A shows needle 34 after being retracted back and stripped off ferrule 103 held in its ferrule compartment 107 by the flexible integrated stripper 135. FIG. 25B is a partial sectional view of needle 34 engaging ferrule 103 in its ferrule compartment 107. The flexible integrated stripper 135 is shown retracted into the bridge channel 134 to permit the needle 34 to pull the ferrule 103 out of its ferrule compartment 107. FIG. 25C illustrates a partially retracted needle after its ferrule 103 is stripped by the flexible integrated stripper 135.
FIGS. 26-30J describe a fourth preferred embodiment of this invention. Unlike the previous three embodiments, this fourth version does not require an additional manual mechanism, like the thumb slide mechanism, to enable ferrule stripping. Instead of pushing a button to activate a stripper, this instrument is more automated to enable stripping the ferrule 103 imply squeezing the lever 36a a second time.
FIG. 26 shows this instrument in a perspective view illustrating window 136 in the right handle half; a comparable window (not shown) is located in the opposite location on the left handle half. These windows permit an instrument user to view from either handle an asymmetric rotating disc 138a that indicates whether the cam needle 139 is in the stripper or non-stripper orientation. Also, note rod 137 mounts into the right handle half to engage the slots in the rotating cam 138. When lever 36a rotates back, cam 138 drives forward, lifts towards the mid stroke, then lowers and rotates about rod 137, as seen in FIGS. 27A-27C.
FIG. 27A shows the rod 1 37 engaging the distal slot in cam 138. The rotating indicator disc 138a is vertically oriented indicating a non-faceted edge of the cam needle 139 faces the ferrule latch 140 (FIG. 27A; also see FIGS. 28-31J). Release of the lever 36a permits the cam needle 139 and its rotational cam 138 to travel back and elevates slightly at mid stroke, where rod 137 enters an obliquely oriented slot, to begin rotating the rotational cam 138 and its attached cam needle 139 (FIG. 27E). By completion of the lever 36a, the full rotation of the rotational cam 138 (FIG. 27A), the needle facet 139b (FIG. 27F) is now oriented towards the ferrule latch 140, which permits ferrule stripping.
FIG. 28 shows the partially retracted cam needle 139 having its ferrule 103 held by ferrule latch 140. Note this illustration shows a pocket 142 recessed in the distal tip 98 for holding the ferrule latch 140.
FIG. 29A shows cam needle 139 oriented with a non-faceted shoulder 139c engaging and lifting the ferrule engaging surface 140g of the ferrule latch 140. The ferrule 103 is not held by the ferrule latch 140, because the ferrule 103 latch 140 is compressed by the non-faceted shoulder 139c pushing against timing surface 140b. The ferrule 103 is able to be pulled from its ferrule compartment 107 by cam needle 139. FIG. 29B shows the distal end of the fourth preferred embodiment with cam needle 139 retracting back through the gap and the ferrule latch 140 engaging into the proximal edge of ferrule 103. FIG. 29B highlights cam needle 139 oriented to have a facet 1 39b towards the ferrule latch 140, to not engage timing surface 140b so that the ferrule engagement surface 140g contacts the proximal edge of ferrule 103. Surfaces 140f and 140e provide contacts to help maintain latch placement in its pocket 142.
FIGS. 30A-30J show one complete cycle of the cam needle 139 traversing the jaw 104, picking up a ferrule 103, the ferrule 103 being returned to its ferrule compartment 107 and the ferrule 103 being stripped by the ferrule latch 140. This cycle reloads the ferrule 103 for another stitch placement. FIG. 30 shows the retracted cam needle 139 oriented with a non-faceted shoulder 1 39c facing the ferrule latch 140, which secures the ferrule 103 with its suture 105 in its ferrule compartment 107 in the distal tip 98. FIG. 30B shows cam needle 139 fully advanced into ferrule 103, with its non-faceted shoulder 139c compressing ferrule latch 140. FIG. 30C shows cam needle 139 pulling ferrule 107 and suture 105 back beyond the compressed ferrule latch 140. At approximately the midpoint of the cam needle 139 retraction, cam needle 139 begins its rotation with ferrule 103 and suture 105 rotating with cam needle 139. FIG. 30E shows cam needle 139 along with its ferrule 103 and suture 105 fully retracted back with its 90° rotation completed. FIG. 30F shows cam needle 139, ferrule 103 and suture 105 advancing back into ferrule compartment 107. A faceted shoulder 139a of cam needle 139 now faces the ferrule latch 140. FIG. 30G shows the cam needle 139, ferrule 103 and suture 105 fully placed back into its ferrule compartment 107. The faceted shoulder 1 39a of cam needle 139 does not cause ferrule latch 140 to compress up or deflect away from the proximal edge of ferrule 103. FIG. 30H shows the retraction of ferrule 103 stopped by ferrule latch 140, stripping ferrule 103 from its partially retracted cam needle 139. FIG. 30J shows the cam needle 139 now fully retracted back and rotated back 180° so that the opposite side of the non-faceted shoulder 139c is oriented towards the ferrule latch. The ferrule 103 is reloaded back into its ferrule compartment 107 and cam needle 139 is ready to advance through more tissue 120, picking up ferrule 103 and pulling it along with its suture 105 back through another bite of tissue 120.
An additional embodiment of the invention, suturing instrument 16, is represented in FIGS. 31-50J. Referring to FIGS. 31-33, show the suturing instrument 16, which represents the SEW-RICHT ^® SR·5 ^® manufactured by LSI SOLUTIONS, Inc. (formerly LaserSurge, Inc.) of Victor, New York, that has been modified to provide a means for both selecting a left needle 144 or right needle 145 via a selector mechanism 146 and selectably stripping a ferrule 103 from the left needle 144 or right needle 145 at its tissue engaging end 16a.
A shaft 147 offers a suture loading window 147a through which a suture 105 loaded at the tissue engaging end 1 6a may be passed into a suture channel 150a of a guide member 150 and subsequently through the instrument 16 and out of a valve controller 19b.
The housing 143 has a body shaped like a pistol having a handle portion 143a, and may be made of a two-piece construction of molded plastic. A left needle 144 and right needle 145 extend from housing 143 through the shaft opening 143c into the shaft 147 and proceeds into the tissue engaging end 16a. Left needle 144 and right needle 145 have a non-tissue engaging end 144a and 145a, respectively, in the housing 143 having a spherical member 148, such as a ball or bearing, attached thereto. The left needle 144, right needle 145, and spherical member 148 may be made of metal, such as surgical stainless steel. The spherical member 148 may have a bore into which the non-tissue engaging end 144a or 145a of the left needle 144 or right needle 145, respectively, extends and joins thereto, such as by welding or brazing.
The suturing instrument 16 includes an actuating member 149 representing a lever 149a having two pins 149b extending into holes 143b in the sides of housing 143 upon which the actuating member 149 is pivotally mounted. The lever 149a of actuating member 149 extends through a lever opening 143d (FIG. 32) in housing 143 to enable pivotal movement about pins 149b. An extension spring 38 is provided which hooks at one end in a notch 149c of actuating member 149 and is wound at the other end around a pin 40 located in holes 143d in the sides of housing 143, such that the actuating member 149 is spring biased to retain actuating member 149 normally in a forward position, fully advanced, as shown for example in FIG. 32. The body of housing 143 has a front pivot stop 143e (FIG. 32 and 33) providing a stop that limits the pivotal movement of the actuating member 149. Grooves 149d are provided in the actuating member 149 which are shaped to retain the non-tissue engaging ends 144a and 145a of the left needle 144 and right needle 145, respectively accompanied by a channel 149e shaped to accept a shuttle 151 that shaped to accommodate the spherical member 148 to be driven forward by an operator pulling the actuating member 149 to pivot actuating member 149 towards handle portion 143a.
An adapter 154 is fixedly attached to the inside of the housing 143 by means of opposing flanges 154d. Through the adapter 1 54, the remainder of the components of the instrument 16 are assembled. The selector mechanism 146 is stationed on the post 154 through the post hole 146c (FIG. 35).
A suture routing tube 47 is provided for the unobstructed passage of suture 105 in housing 143. Suture routing tube 47 has one end received in valve assembly 19 at the bottom of handle portion 143a of housing 143 and extends through the suture routing tube notch 143h (FIG. 33) along the interior of the left side of the housing 143, through a routing tube passageway 1 54e along the left side of the adapter 154 (FIG. 40B). The other end of the suture routing tube 47 is then mounted in a suture routing tube hole 51 a in gasket member 51. Gasket member 51 further has two needle holes 51 b and 51 c through which right needle 145 and left needle 144 respectively extend. The gasket 51 may be made of medical grade rubber, such as Santoprene®.
A longitudinal guide member 150 provides multiple tracks along its length, including a suture channel 150a for unhindered passage of suture 105 extending from opening 51 a of gasket 51, a left needle channel 150b to aid in guidance of the left needle 144 as it extends towards the distal tip 16a of instrument 16, and a right needle track 150c to aid in the guidance of the right needle 145 as it extends towards the distal tip 16a of instrument 16. The guide member 1 50 may be made of an extruded flexible material such as Tecoflex^®. A shaft 147 is provided in which a D-shaped end 147b is registered into a corresponding shaped opening in adapter 1 54, and a threaded nut 54 having an opening which extends over shaft 147, screws onto the end of the adapter 154 to secure the shaft 147 to the adapter 154. With the gasket member 51 loaded first into the shaft 147, guide member 150 inserted into the shaft 147 through a distal opening 147c extends from the gasket member 51 through the shaft 147. In this manner, channels 1 50a, 1 50b, and 1 50c each form a passage with the interior surface of shaft 147. The left needle channel 150b and right needle channel 150c serve as guides to direct the passage of the left needle 144 and right needle 145, respectively, as well to prevent loss of motion that may be encountered if the needles 144 and 145 meet resistance and the build up of stress causes the needles 144 and 145 to undulate. The suture channel provides a smooth bore through which suture 105 can pass freely on its path through gasket member 51, suture routing tube 47 and out of instrument 16 through the valve controller 19b. The shaft 147 may be made of stainless steel, or other rigid material, and has for example an outside diameter of 0.516 cm (0.203 inches). (Note for other applications, such as flexible endoscopy, this tube could be flexible.) Inside shaft 147, gasket member 51 has a ring 51 d, which frictionally engages the interior surface of shaft 147. Suture routing tube hole 51 a of the gasket member 51 is of a diameter such that the suture routing tube 47 fits tightly therein and provides a seal around suture routing tube 47. The suture routing tube 47 may be held in place in the suture routing tube hole 51 a by friction alone, but an adhesive may also be used. Left needle hole 51 c and right needle hole 51 b are of a larger diameter than the left and right needles 144 and 145, respectively, except for a small section of holes 51c and 51 b where the diameter reduces to form flaps of gasket material which seal around the left and right needles 144 and 145, respectively. This enables movement of the left and right needle 144 and 145, respectively back and forth while maintaining a seal about the left needle 144 and right needle 145. One feature of the gasket member 51 is that it enables sealing of the shaft 147 as well.
The guide member 150 is received into the shaft 147 such that the guide member 150 abuts the gasket member 51 and engages a distal tip 152. The distal tip 152 is fixedly attached into the distal opening 147c of the shaft 147 by a mechanical means such a metal deformation in which small dents 147d are formed and the metal displaced in the shaft 147 is forced into the four recessed pockets 1 52b (FIG. 33), i.e., two on each side of the distal tip 152. An optional valve assembly 19 can be provided at the bottom of the handle portion 143a of housing 143, as shown in FIG. 33, having a valve seat 19a and a valve controller 19b. Valve seat 19a is composed of a medical grade rubber, such as Santoprene^®, and has a through hole 76 extending into an interior chamber. A valve controller 1 9b composed of molded plastic, or other rigid material, has a circular section through an opening and a surface forming a cam that can be turned to select a valve fully open to intermediate partially open to a fully closed position. The suture routing tube 47 is received in hole 76 of valve seat 19a, as shown in FIG. 33, such that suture 105 material can pass through openings of the valve seat 1 9a and then through the valve controller 19b.
Referring to FIGS. 32 and 33, the tissue engaging end 16a of the suturing instrument 16 is shown having the distal tip 152 which is mounted in a shaft 147, such that the front section 1 52a of the distal tip 152 extends from the shaft 147. Where FIG. 32A is an enlarged partial side view of the distal tip 152 showing the front section 1 52a, the jaw opening 1 52f, and the ferrule latch pocket 1 52g, all of the distal tip 152, along with a ferrule latch 153 showing the tissue engaging end 16a of instrument 16 as it is fixed to the shaft 147.
As shown in FIGS. 34A and 34B, an actuating member 149 is pivotally mounted in holes 143b of housing 143 via two pins 149b. The actuating member can be constructed of a molded plastic. A pair of grooves 149d accepts and contain the non-tissue engaging ends 144a and 145a of the left needle 144 and right needle 145, respectively, guiding the spherical members 148 into the channel 149e which accommodates a shuttle 1 51. By maneuvering the shuttle 1 51 across the channel 149e, either the left needle 144 or right needle 145 can be selected to advance. For instance, if the shuttle 151 is positioned to the left side of the actuating member 149, the left needle 144 will advance upon the retracting action of the actuating member 149. The right needle 145 will remain stationary throughout the pivotal range of the actuating member 149 due to the clearance profile 149f. This embodiment includes a mechanism to prevent selection of the left needle 144 or right needle 145 during a sequence of operation that could damage the instrument. It is preferred to select the left needle 144 or right needle 145 only before actuating the lever 149a. The actuating member 149 has a left advancing track 149g, a right advancing track 149h, and a selection track 149j located along the surface of the clearance profile 149f. While a follower pin 146c of a selector mechanism 146 (FIG. 35) engages in the left advancing track 149g of the actuating member 149, the selector mechanism 146 cannot be manipulated until the actuating member 149 is returned to its full advanced state. At this point, and only this point, the follower pin 146c of the selector mechanism 146 can traverse the selection track 149j so that a shuttle 1 51 can be manipulated to capture a spherical member 148 of the left needle 144 or right needle 145 to allow advancement.
FIG. 35 represents a selector mechanism 146 of FIG. 33. The arm 146a is attached through a post hole 146c to the post 1 54c of the adapter 154 (FIG. 33) such that the selector mechanism 146 can only be manipulated in a back and forth motion. The arm 146a extends out of the selector slot 143g in the housing 143 to allow an operator to manipulate the selector mechanism 146 to select the left needle 144 or the right needle 145. The selection of the left or right needle 144 or 145, respectively, is accomplished by a shuttle actuator 146b incorporated into the arm 146a of the selector mechanism 146. A shuttle groove 146e envelopes a tongue 151 a protruding from a shuttle 151. The movement of the selector mechanism 146 thus causes the shuttle 151 to the change position and shroud a spherical member 148 of either the left needle 144 or the right needle 145 to allow for either the left needle 144 or the right needle 145 to advance. A spherical member channel 146g of selector mechanism 146 provides clearance for the spherical members 148 so that the shuttle 151 can travel freely across the channel 149e of the actuating member 149 (FIG. 33). A needle clearance 146f is provided to allow the left needle 144 or right needle 145 (whichever is not being advanced) to remain free of contact with moving components and subsequently remain stationary. A follower pin 146d of selector mechanism 146 is provided to engage in the left advancing track 149g, right advancing track 149h, and the selector track 149j to prevent selection operations at inappropriate stages of the instrument 16 cycle of operation. The selector mechanism 146 can be made of molded plastic or other rigid material.
FIG. 36 illustrates a shuttle 151 that, through a ball pocket 151b, encompasses a spherical member 148 to allow for either left needle 144 or right needle 145 advancement. The shuttle 151, and its rail 151 c, sits in a channel 149e of the actuating member 149 such that it allows free lateral movement while preventing component disassembly similar to a ball-and-socket joint.
FIGS. 37A-38B depict the instrument 16 in a partial right perspective view with the housing 143 removed. The illustrations clarify the deployment of the selector mechanism 146, the actuation of the actuating member 149, and the subsequent retraction of the left needle 144 and the right needle 145.
FIG. 37A is a partial right perspective view of the instrument 16 with the housing 143 removed. The arm 146a of selector mechanism 146 is positioned over the left needle 144 thus locating the shuttle actuator 146b and shuttle 151 onto the left needle 144. The actuating member 149 is fully advanced and both the left needle 144 and the right needle 145 are fully retracted.
FIG. 37B is a partial right perspective view of the instrument 16 with housing 143 removed. The arm 146a of selector mechanism 146 is positioned over the left needle 144. The actuating member 149 is fully retracted as evidenced by the rearward motion of the lever 149a rotating about pins 149b. The shuttle 151 in channel 149e exits the shuttle actuator 146b and fully advances the left needle 144 while the non-tissue engaging end 145a of the right needle 145 is unobstructed by the needle clearance 146f of the shuttle actuator 146b of the selector mechanism 146 allowing the right needle 145 to remain fully retracted.
FIG. 38A is a partial right perspective view of the instrument 16 with the housing 143 removed and the actuating member 149 in its fully advanced position. The arm 146a of selector mechanism 146 is positioned over the right needle 145 thus locating the shuttle actuator 146b and shuttle 1 51 onto the right needle 145. With the actuating member 149 fully advanced, both the left needle 144 and the right needle 145 are fully retracted.
FIG. 38B is a partial right perspective view of the instrument 16 with housing 143 removed. The arm 146a of selector mechanism 146 is positioned over the right needle 145. The actuating member 149 is fully retracted as evidenced by the rearward motion of the lever 149a rotating about pins 149b. The shuttle 151 in channel 149e exits the shuttle actuator 146b and fully advances the right needle 145 while the non-tissue engaging end 144a of the left needle 144 is unobstructed by the needle clearance 146f of the shuttle actuator 146b of the selector mechanism 146 allowing the left needle 144 to remain fully retracted.
FIGS. 39A-39F detail one complete cycle of an actuation sequence of instrument 16. The views depict the instrument 16 in a proximal partial right perspective view with the housing 143 removed. The views highlight the function of the selector mechanism 146 and its interface with an actuating member 149 as the actuating member 149 pivots through its range of motion about pins 149b.
FIG. 39A shows the actuating member 149 fully advanced. The selector mechanism 146 is positioned over the left needle 144 where the shuttle actuator 146b maneuvers the shuttle 151 through the channel 149e of the actuating member 149 onto the left needle 144 and the follower pin 146d is engaged in the left advancing track 149g of the actuating member 149.
FIG. 39B shows the selector mechanism 146 in position over the left needle 144 and the actuating member 149 fully retracted as evidenced by the rearward motion of the lever 149a about pins 149b. As the follower pin 146d travels in the left advancing track 149g of the actuating member 149, the shuttle 151 exits the shuttle actuator 146b of the selector mechanism 146 and fully advances the left needle 144 while the right needle 145 remains fully retracted.
FIG. 39C shows the selector mechanism 146 in position over the left needle 144 and the actuating member 149 returned to its fully advanced state as indicated by the forward motion of the lever 149a about pins 149b. The follower pin 146d remains in the left advancing track 149g of the actuating member 149 while the shuttle 1 51 returns to the shuttle actuator 146b thus retracting the left needle 144.
FIG. 39D shows the actuating member 149 fully advanced. The selector mechanism 146 is positioned over the right needle 145 where the shuttle actuator 146b maneuvers the shuttle 151 through the channel 149e of the actuating member 149 onto the right needle 145 and the follower pin 146d traverses the selection track 149j of the actuating member 149. With the actuating member 149 in its fully advanced state, the selector mechanism 146 can only now be activated precluding the selection process during advancement of the left needle 144 or right needle 145 as selection of the left needle 144 or right needle 145 is only desired while both the left needle 144 or right needle 145 are fully retracted.
FIG. 39E shows the selector mechanism 146 in position over the right needle 145 and the actuating member 149 fully retracted as evidenced by the rearward motion of the lever 149a about pins 149b. As the follower pin 146d travels in the right advancing track 149h of the actuating member 149, the shuttle 151 exits the shuttle actuator 146b of the selector mechanism 146 and fully advances the right needle 145 while the left needle 144 remains fully retracted.
FIG. 39F shows the selector mechanism 146 in position over the right needle 145 and the actuating member 149 returned to its fully advanced state as indicated by the forward motion of the lever 149a about pins 149b. The follower pin 146d remains in the right advancing track 149h of the actuati ng member 149 while the shuttle 151 returns to the shuttle actuator 146b thus retracting the right needle 145.
FIG. 40A is a perspective view of the adapter 154 and spring arms 1 56. The adapter 154 is fixedly attached to the housing 143 via two flanges 154d and coupled to the selector mechanism 146 by way of the post 154c. The mounting end 1 56a of spring arms 156 attach to the adapter 154 at the mounting holes 1 54a. The mounting holes 1 54a are of a diameter that allows a secure fit of the mounting ends 1 56a of the spring arms 156 such that the spring arms 156 cannot freely move. The followers 15 6b of the spring arms 156 then locate into the follower holes 1 54b of the adapter 1 54. The follower holes 154b are of a diameter that is slightly larger than the followers 156b of the spring arms 156 to allow for free vertical movement of the followers 156b. This feature permits the spring arm 1 56 to engage the rotation cam 155 at all times under a light pressure. The adapter 1 54 can be manufactured via plastic injection molding and the spring arms 156 are comprised of rigidly formed stainless steel wire.
FIG. 40B is a proximal perspective view of the adapter 1 54 showing the rotation cam bores 154f through which the rotation cams 155 pass. It is through the rotation cam bores 154f that the rotation cams 155 are installed in order to engage the followers 156b of the spring arms 156. Also visible from this vantage point is the suture routing tube passage 1 54e that allows for the routing of the suture routing tube 47 while maintaining its position safely away from the path of the rotation cams 1 55.
FIGS. 41A-41E detail the operational aspects of the rotation cam 155 through a variety of views. The rotation cam 155 allows for the rotation of the left needle 144 or right needle 145 upon initiation of the actuating member 149. The rotation cam 1 55 incorporates features that allow for straight advancing of the left needle 144 or right needle 145 while also allowing for the 90 degree rotation of each during retraction. Other aspects of the rotation cam 1 55 prevent undesired operation during the operation of suturing instrument 16 via various interlocks engaged by the follower 1 56b of the spring arm 156. The rotation cam can be precision manufactured of stainless steel or other medical-grade rigid material via a machining process, metal injection molding process, or even a selective laser sintering process.
FIG. 41 A is a side view of the rotation cam 155 showing an advancing track 1 55b and a rotation track 155c. Each advancing track 155b and rotation track 155c are represented every 90 degrees along the circumference of the rotation cam 155. This permits the advancing and subsequent rotation upon retraction of the left needle 144 or right needle 145 when the actuating member 149 is employed. At the end of each advancing track 1 55b there is an advancing stop. 155d which is, in essence, a fall-off for the follower 1 56b of spring arm 156 so that the follower 156b cannot travel backward in the advancing track 155b. The same fall-off feature, a rotation stop 155e, is incorporated at the end of the rotation track 155c so that once the follower 1 56b of the spring arm 156 falls off the rotation stop 1 55e end of the rotation track 1 55c, the follower 1 56b cannot travel in retrospect through the rotation track 155c of rotation cam 1 55. This series of stops sanctions the continuous 360 degree rotation of the left needle 144 or right needle 145 in 90 degree increments in only direction.
FIG. 41 B is a cross-sectional view of the rotation cam 15 5 of FIG. 41 A showing the needle bore 155a through which the left needle 144 or right needle 145 can pass through and affix via a shrink fit process, welding, or by the use of adhesives. In this view, the four advancing tracks 155b are visible. Each advancing track 155b consists of an advancing ramp 155f that the follower 156b of spring arm 156 must follow, rising until it eventually falls off at the advancing stop 155d.
FIG. 41C is a side view of a flat pattern of the rotation cam 155 cam profile. Note the orientation of the advancing tracks 155 band rotation tracks 155c every 90 degrees. Readily visible are the advancing stop 1 55d and the rotation stop 1 55e.
FIG. 41 D is a perspective view of the rotation cam 1 55 along with the needle bore 155a. The advancing track 155b and rotation track 155c are visible. Also evident is an advancing stop 155d created by the intersection of the advancing ramp 1 55f and rotation track 1 55b and a rotation stop 1 55e formed at the intersection of the rotation ramp 1 55g and the advancing track 155b.
FIG. 41 E is a cross-sectional view of the rotation cam 155 of FIG. 41 D detailing the needle bore 155a through which the left needle 14 or right needle 145 can pass and be fastened unto and also showing the advancing track 155b along with its advancing ramp 1 55f and its consequent advancing stop 1 55d. The rotation stop 1 55e is shown intersecting with the advancing track 155b after falling off abruptly from the rotation ramp 155g (FIG. 41 D).
FIG. 42 is a perspective view of a typical left needle 144 showing the spherical member 148 attached to the non-tissue engaging end 1 44a. Note that the same features do apply to the right needle 145.
FIG. 42A is a detail view of the tissue-engaging end 144b of the needle 144 of FIG. 42 showing the engaging latch surface 144d, which when oriented towards the ferrule latch 153 extends down radially to push down upon the ferrule latch 153, thereby moving the ferrule contact edge 1 53f out of the path of the ferrule 103. It is this feature that allows the suture 105 and its attached ferrule 103 to be removed from its ferrule compartment 152h of the distal tip 152. As the needle 144 advances into the ferrule 103 the ferrule latch 153 is engaged by one of the engaging latch surfaces 144d, thus the ferrule latch 153 will be forced down allowing withdrawal of the ferrule 103 and its attached suture 105.
FIG. 42B is a detail view of the tissue-engaging end 144b of the needle 144 of FIG. 42 showing the non-engaging latch surface 144c. It is this feature that allows the suture 105 and its attached ferrule 103 to be reset into its ferrule compartment 1 52h of the distal tip 152. As the needle 144 returns the ferrule 103 to its compartment 152h, the ferrule latch 153 is not engaged because this surface is faceted or has a shorter radial length, thus the ferrule latch 153 will remain extended engaging and retaining the ferrule 103 with its ferrule contact edge 153f upon needle 144 retraction.
FIGS. 43-47B detail the sequence of operation induced by the actuation of the actuating member 149, advancing and subsequent retraction of the left needle 144 (note that the same sequence applies to the right needle 145 which is not shown in this sequence to better illustrate the complete cycling of the left needle 144), and the function of the rotation cam 155.
FIG. 43 is a partial right perspective view of the instrument 16 with housing 143 removed showing a partial cross-section of the adapter 1 54. The actuating member 149 is fully advanced and the ball pocket 151 b of the shuttle 151 is retaining the spherical member 148 of the needle 144 in its fully retracted position. The rotation cam 155 is fully retracted, and the follower 1 56b of the spring arm 156 is engaged in the trough of the advancing track 155b of the rotation cam 155.
FIG. 43A is an enlarged view of the adapter 154, rotation cam 155, and spring arm 156 of FIG. 43. Note that the follower 156b of the spring arm 156 is fully engaged in the advancing track 1 55b of the fully retracted rotation cam 155.
FIG. 43B is an enlarged view of the tissue engaging end 144b of the needle 144 showing its orientation with respect to the sequence shown in FIG. 43. The engaging latch surfaces 144d are oriented vertically to engage the ferrule latch 153.
FIG. 44 is a partial right perspective view of the instrument 16 with housing 143 removed showing a partial cross-section of the adapter 1 54. The actuating member 149 is partially retracted as evidenced by the rearward movement of the lever 149a pivoting about pins 149b. The spherical member 148 retained in the ball pocket 151 b of the shuttle 151 is partially advanced thus partially advancing the left needle 144. The rotation cam 155 begins it advance and the follower 156b of the spring arm 156 rises as it follows the advancing ramp 1 55f of the advancing track 155b of the rotation cam 155.
FIG. 44A is an enlarged view of the adapter 154, rotation cam 1 55, and spring arm 156 of FIG. 44. Note that the follower 1 56b of the spring arm 156 is beginning to rise as it rides up the advancing ramp in the advancing track 155b of the partially advanced rotation cam 155.
FIG. 45 is a partial right perspective view of the instrument 16 with housing 143 removed showing a partial cross-section of the adapter 1 54. The actuating member 149 is fully retracted as evidenced by the rearward movement of the lever 149a pivoting about pins 149b. The spherical member 148 retained in the ball pocket 151 b of the shuttle 151 is fully advanced thus completely advancing the needle 144. The rotation cam 155 is fully advanced and the follower 156b of the spring arm 1 56 falls off the advancing stop 155d at the end of the advancing ramp 1 55f and continues to the end of the advancing track 155 b of the rotation cam 155. FIG. 45A is an enlarged view of the adapter 154, rotation cam 1 55, and spring arm 156 of FIG. 45. Note that the follower 1 56b of the spring arm 156 falls as it passes the advancing stop 155d precluding it from traversing back through the advancing track 1 55b of the fully advanced rotation cam 155.
FIG. 45B is an enlarged view of the tissue engaging end 144b of the needle 144 showing its orientation with respect to the sequence shown in FIG. 45. The engaging latch surfaces 144d are oriented vertically to engage the ferrule latch 153.
FIG. 46 is a partial right perspective view of the instrument 16 with housing 143 removed showing a partial cross-section of the adapter 154. The actuating member 149 is partially advanced as evidenced by the forward movement of the lever 149a pivoting about pins 149b. The spherical member 148 retained in the ball pocket 1 5 1 b of the shuttle 151 begins retracting thus retracting the needle 144. The rotation cam 1 55 begins its retraction and partial rotation as the follower 156b of the spring arm 156 travels through the rotation track 155c and rises as it progress up the rotation ramp 155g of the rotation cam 155.
FIG. 46A is an enlarged view of the adapter 1 54, rotation cam 1 55, and spring arm 156 of FIG. 46. Note that the follower 1 56b of the spring arm 156 rises as it passes the advancing stop 1 55d (which is rotated out of view) into to the rotation track 155c and up the rotation ramp 155g of the partially retracted rotation cam 155.
FIG. 46B is an enlarged view of the tissue engaging end 144b of the needle 144 showing its orientation with respect to the sequence shown in FIG. 46. The engaging latch surfaces 144d are rotated slightly, bringing the non-engaging latch surfaces 144c closer to vertical.
FIG. 47 is a partial right perspective view of the instrument 16 with housing 1.43 removed showing a partial cross-section of the adapter 154. The actuating member 149 is fully advanced as evidenced by the forward movement of the lever 149a pivoting about pins 149b. The spherical member 148 retained in the ball pocket 151 b of the shuttle 151 is fully retracted thus completely retracting the needle 144. The rotation cam 1 55 completes its retraction and full 90 degree rotation as the follower 1 56b of the spring arm 156 travels through the rotation track 155c, falls off the rotation stop 155e at the end of the rotation ramp 1 55g (which have rotated out of view) and continues into the next advancing track 155b of rotation cam 155.
FIG. 47A is an enlarged view of the adapter 1 54, rotation cam 1 55, and spring arm 156 of FIG. 47. Note that the follower 156b of the spring arm 1 56 falls as it passes the rotation stop precluding it from traversing back into the rotation track 155c of the fully retracted rotation cam 155.
FIG. 47B is an enlarged view of the tissue engaging end 144b of the needle 144 showing its orientation with respect to the sequence shown in FIG. 47. The needle 144 has completed its 90 degree rotation and the non-engaging latch surfaces 144c are oriented vertically so as to not engage the ferrule latch 153.
FIG. 48 is a partial perspective view of the underside of the distal end 1 6a of instrument 16. The ferrule latch 153 is inserted into the latch pocket 152g of the distal tip 152. The ferrule latch 153 can be retained via force fit, adhesive, or welding and can be made from medical grade stainless steel or materials with a high elasticity.
FIG. 49A is a perspective view of the ferrule latch 153 of FIG. 48. Detailed is the functioning of the ferrule latch 153 when engaged by the left needle 144. The engaging latch surface 144d of the left needle 144 advances past a needle ramp 153g and onto the left needle relief 1 53d forcing the ferrule latch 153 on its rigid base 153a to flex at the upper spring section 153b pushing the ferrule contact edge down and consequently releasing the ferrule 103 from its ferrule compartment 152h in the distal tip 152.
FIG. 49B is a perspective view of the ferrule latch 153 of FIG. 48. Detailed is the functioning of the ferrule latch 153 when engaged by the right needle 145. The engaging latch surface 145d of the right needle 145 advances past a needle ramp 1 53g and onto the right needle relief 1 53e forcing the ferrule latch 1 53 on its rigid base 153a to flex at the lower spring section 1 53c pushing the ferrule contact edge down and consequently releasing the ferrule 103 from its ferrule compartment 1 52h in the distal tip 152.
FIG. 50A-50J are perspective views of the underside of the distal end 16a of the instrument 16 exhibiting the sequence of events transpiring as the left needle 144 is actuated by the employment of the actuating member 149 as applied to the ferrule latch 153 and the ferrule 103 and its attached suture 105. Note that in addition to the left needle 144, the following operations can be utilized to describe the right needle 145.
FIG. 50A represents the instrument 16 with the actuating member 149 fully advanced. Both the left needle 144 and right needle 145 are fully retracted inside the distal tip 152. The ferrule latch 153 rests, fully extended, inside the latch pocket 1 52g of the distal tip 152. Both ferrules 103 and attached sutures 105 are retained in their respective ferrule compartments 152h by the ferrule latch 153 and is best described by the actuating member 149 and rotation cam 1 55 operation illustrated in FIG. 43 and 43A.
FIG. 50B represents the instrument 16 with the actuating member 149 partially retracted. The left needle 144 begins to advance across the jaw 1 52f of the distal tip 152. The ferrule latch 153 rests, fully extended, inside the latch pocket 152g of the distal tip 152. Both ferrules 103 and attached sutures 105 are retained in their respective ferrule compartments 1 52h by the ferrule latch 153 and is best described by the actuating member 149 and rotation cam 155 operation illustrated in FIG. 44 and 44A.
FIG. 50C represents the instrument 16 with the actuating member 149 fully retracted. The left needle 144 has fully traversed the jaw 152f of the distal tip 152. The engaging latch surface 144d (most visible in FIG. 50B) of the left needle 144 contacts the left needle relief 1 53d (most visible in FIG. 50B) of the ferrule latch 153 and in turn forces the upper spring section 153b of the ferrule latch 153 to flex downward and release the ferrule 103 from its ferrule compartment 152h and is best described by the actuating member 149 and rotation cam 155 operation illustrated in FIG. 45 and 45A. FIG. 50D represents the instrument 16 with the actuating member 149 partially advanced. The left needle 144 begins to retract back across the jaw 1 52f of the distal tip 1 52 and start its 90 degree rotation so as to return the ferrule 103 to its compartment 152 h on the next actuating member 149 employment sequence. The ferrule latch 153 free of the engaging latch surface 144d of the left needle 144 fully extends inside the latch pocket 1 52g of the distal tip 1 52. The left ferrule 103, now affixed to the left needle 144 and free from its ferrule compartment 152h also traverses the jaw 152f of the distal tip 152 and is best described by the actuating member 149 and rotation cam 155 operation illustrated in FIG. 46 and 46A.
FIG. 50E represents the instrument 16 with the actuating member 149 fully advanced. The left needle 144 fully retracts across the jaw 152f and into the distal tip 1 52 and completes its 90 degree rotation to return the ferrule 103 to its compartment 152 on the next actuating member 149 employment sequence and is best described by the actuating member 149 and rotation cam 1 55 operation illustrated in FIG. 47 and 47A.
FIG. 50F represents the instrument 16 with the actuating member 149 partially retracted. The left needle 144 with the non-engaging latch surface 144c now vertical partially advances across the jaw 1 52f as to return the ferrule 103 to its compartment 152 h and is best described by the actuating member 149 and rotation cam 1 55 operation illustrated in FIG. 44 and 44A.
FIG. 50G represents the instrument 1 6 with the actuating member 149 fully retracted. The left needle 144 is fully advanced across the jaw 1 52f returning the ferrule 103 to its compartment 1 52h with the non-engaging latch surface 144c now vertical, the left needle 144 does not engage the left needle relief 153d (best viewed in FIG. 50H), and consequently the ferrule latch 1 53 does not flex and remains in position to retain the ferrule 103 and is best described by the actuating member 149 and rotation cam 1 55 operation illustrated in FIG. 45 and 45A.
FIG. 50H represents the instrument 16 with the actuating member 149 partially advanced. The left need le 144 begins to retract back across the jaw 152f of the distal tip 152 and start another 90 degree rotation so as to remove the ferrule 103 from its compartment 152h on the next actuating member 149 employment sequence. The ferrule latch 153 free of the engaging latch surface 144d of the left needle 144 is fully extended and inside the latch pocket 1 52g of the distal tip 152 and retains the ferrules 103 and is best described by the actuating member 149 and rotation cam 1 55 operation illustrated in FIG. 46 and 46A.
FIG. 50J represents the instrument 16 with the actuating member 149 fully advanced. Both the left needle 144 and right needle 145 are fully retracted inside the distal tip 152. The ferrule latch 153 rests, fully extended, inside the latch pocket 152g of the distal tip 152. Both ferrules 103 and attached sutures 105 are retained in their respective ferrule compartments 152h by the ferrule latch 153 and is best described by the actuating member 149 and rotation cam 155 operation illustrated in FIG. 47 and 47A.
FIG. 51 A depicts the first step in tying a novel knot with the instrument 16 of Figure 31. This step is known as a "surgeon's" knot and is used for apposing the tissue 159. The suture 105 having been passed through opposing tissue 159 is arranged such that the ferrule end 158b of the suture 105 is passed over the free end 158a of the suture 105, then under the free end 158a of the suture 105, then finally through the closed loop created by the free end 158a and ferrule end 1 58b of the suture 105. This process is conducted a total of two times to produce two throws 158c of the ferrule end 1 58b of suture 105 around the free end 158a of the suture 105.
FIG. 51 B shows the correct procedure for sliding the two throws 158c produced in FIG. 51A towards the wound closure site of the tissue 159. The instrument 16 of FIG. 31 is maneuvered such that the ferrule end 158b of the suture 105 is pulled taut and straight while the free end 158a of the suture 105 forms the two throws 1 58c created in FIG. 51 A and can be advanced towards the closure site of the tissue 159.
FIG. 51C depicts the second step in tying the knot with the instrument 16 of FIG. 31. This step is referred to as an "end-point" knot and is used to stabilize the suture 105 and help to secure the surgeon's knot performed in FIGS. 51 A and 51 B. The suture 105 is again arranged such that the ferrule end 158b of the suture 105 is passed over the free end 158a of the suture 105, then under the free end 158a of the suture 105, then finally through the closed loop created by the free end 158a and ferrule end 1 58b of the suture 105. This process creates one throw 158c about the free end 158a of the suture 105.
FIG. 51 D shows the procedure for sliding the throw 158c produced in FIG. 53C towards the wound closure site of the tissue 159. The instrument 16 of FIG. 31 is maneuvered such that the ferrule end 1 58b of the suture 105 is pulled taut and the free end 1 58a of the suture 105 forms the throw 1 58c created in FIG. 51C and can be advanced towards the closure site of the tissue 159 onto the surgeon's knot created in FIGS. 51A and 51 B.
FIG. 51 E depicts the third step in tying knot with the instrument 16 of FIG. 31. This step is referred to as "locking" and is used to secure the suture 105 and lock over the end-point knot performed in FIGS. 51C and 51 D. The suture 105 is again arranged such that the ferrule end 1 58b of the suture 105 is passed over the free end 158a of the suture 105, then under the free end 158a of the suture 105, then finally through the closed loop created by the free end 158a and ferrule end 158b of the suture 105. This process creates one throw 1 58c about the free end 158a of the suture 105.
FIG. 51 F shows the procedure for advancing the throw 158c produced in FIG. 51 E towards the wound closure site of the tissue 159. At this point, the free end 158a of the suture 105 is pulled taut and the throw 1 58c created in FIG. 51 E now formed from the ferrule end 158b of the suture 105 can be advanced towards the closure site of the tissue 159and onto the end-point knot created in FIGS. 51C and 51 D. By producing the closed loop throw 158c in the ferrule end 158b of the suture 105 instead of the free end 158a of the suture 105 as shown in FIGS. 51 A and 51 B, both the free end 158a of suture 105 and the ferrule end 158b of the suture 105 will have tight bends and will effectively lock the knot.
FIG. 51 G depicts the fourth step in tying this knot with the instrument 16 of FIG. 31. This step is referred to as a "finishing" knot and is used to secure the suture 105 over the locking knot performed in FIGS.51 E and 51 F, providing sufficient holding forces to maintain the locking knot and conclude the knot tying process, but more throws 1 58c can be placed if desired by the operator. The suture 105 is again arranged such that the ferrule end 1 58b of the suture 105 is passed over the free end 158a of the suture 105, then under the free end 1 58a of the suture 105, then finally through the closed loop created by the free end 158a and ferrule end 1 58b of the suture 105. This process creates one throw 158c about the free end 158a of the suture 105.
FIG. 51H shows the procedure for sliding the throw 158c produced in FIG. 51 G towards the wound closure site of the tissue 159. The instrument 16 of FIG. 31 is maneuvered such that the ferrule end 158b of the suture 105 is taut and the free end 158a of the suture 105 and the throw 1 58c created in FIG. 51C can be advanced towards the closure site of the tissue 1 59 and onto the locking knot created in FIGS. 51E and 51F.
The foregoing examples of specific compositions, processes, articles and/or apparatus employed in the practice of the present invention are, of course, intended to be illustrative rather than limiting, and it will be apparent the numerous variations and modification of these specific embodiments may be practiced within the scope of the appended claims.

Claims

A surgical suturing instrument (16) comprising:
a reciprocating tissue penetrating member;

a suture holder;

means for sequentially coupling the reciprocating tissue penetrating member to the suture holder for drawing a length of suture through a tissue section and releasing the reciprocating tissue penetrating member from the suture holder;

an elongated shaft (16b);

a tissue engaging gap formed proximal to an end of the shaft (16b);

in which the reciprocating tissue penetrating member comprises a needle (34) reciprocally movable across the gap from a proximal end of the gap to a distal end of the gap;

the needle (34) having a tip;

in which the means for alternately coupling the tip to the suture holder for drawing a length, of suture through a tissue section and releasing the reciprocating tissue penetrating member from the suture holder comprises a suture holder receiving aperture at a distal end of the gap for selectively holding and releasing the suture holder so that in a first mode, the needle (34) engages the suture holder and draws a suture across the gap, and in a second mode, the suture holder is retained in the aperture and the needle (34) separates from the suture holder and is retracted across the gap leaving the suture holder in the aperture and automatically switching between the first and second modes on successive movements of the tissue penetrating member.
The surgical suturing instrument (16) of claim 1, characterized by a needle actuator on the handle for selectively advancing and retracting the needle (34) across the gap.
The surgical suturing instrument (16) of any of the preceding claims, characterized in that the needle (34) has an asymmetrical cross section.
The surgical suturing instrument (16) of claim 3, characterized by a means for rotating the needle (34) between a first rotational position in the first mode and a second rotational position in the second mode.
The surgical suturing instrument (16) of claim 4, characterized by a suture holder latch activated by the needle (34) for selectively retaining the suture holder in the gap.
The surgical suturing instrument (16) of claim 1, characterized by a clamp for retaining the suture holder in the suture holder receiving aperture in the second mode and releasing the suture holder in the first mode.
The surgical suturing instrument (16) of claim 6, characterized by a clamp activator reciprocally movable to engage the clamp to cause it to retain the suture holder in the suture holder receiving aperture in the second mode and release the suture holder in the first mode.
The surgical suturing instrument (16) of claim 5, characterized in that the needle (34) comprises a tissue engaging end (16a) having a latch engaging surface.
The surgical suturing instrument (16) of claim 8, characterized in that the suture holder latch comprises a suture holder contact edge selectively engaging a suture holder for stripping the suture holder off the needle (34).
The surgical suturing instrument (16) of claim 9, characterized in that the latch engaging surface engages the suture holder latch and moves the suture holder contact edge to a retracted position where it does not engage the suture holder.
The surgical suturing instrument (16) of claim 8, characterized in that the needle (34) comprises a non latch engaging surface.
The surgical suturing instrument (16) of claim 11, characterized in that the latch engaging surface and the non latch engaging surface are arranged radially around the tissue engaging ends (16a) of the needle (34).
The surgical suturing instrument (16) of any of the preceding claims, characterized by at least one rotation cam (155) attached to a needle (34), and at least one cam follower.
The surgical suturing instrument (16) of claim 13, characterized by at least one rotation bore receiving the rotation cam (155).
The surgical suturing instrument (16) of claim 14, characterized in that the rotation cam (155) comprises an advancing track (155b) and a rotation track (155c).
The surgical suturing instrument (16) of claim 15, characterized in that the advancing track (155b) comprises an advancing stop (155d) preventing the cam follower from following the advancing track (155b) in a backward direction.
The surgical suturing instrument (16) of claim 15, characterized in that the rotation track (155c) extends over 90 degrees.
The surgical suturing instrument (16) of claim 15, characterized in that the rotation track (155c) comprises a rotation stop (155e) preventing the cam follower from following the rotation track (155c) in a backward direction.